基于疾病诊断相关分组的住院患者抗菌药物临床应用管理探索

Explorations on diagnosis related groups based antibiotics clinical application management for inpatients

目的探究基于疾病诊断相关分组(DRG)的住院患者抗菌药物临床应用管理。方法选取某三级甲等综合医院2020年4-6月出院患者为研究对象,从基于DRG的医院质量管理与绩效评价省级平台获取DRG分组数据,从该院医院信息系统提取抗菌药物应用数据。基于DRG分组对抗菌药物应用的总体情况,以及不同时间、科室与医师间的使用情况进行描述性统计分析。结果共纳入出院病例8263例,涉及491组DRG;其中4193例应用抗生素,涉及417组DRG。各DRG组间抗菌药物使用强度(AUD)有较大差异,最大的为290 DDDs/100人天(EM18C组),最小的0.21DDDs/100人天(FM15B组)。分析该院4-6月入组病例数最多的NS06Z组,抗菌药物使用率随时间变化较小。分析抗菌药物应用典型病例组EM11A组,部分科室和医师存在AUD和抗菌药物使用率均过高或联合用药率过高问题。结论基于DRG进行抗菌药物临床应用的评价和监管更为科学合理,有助于实现抗菌药物临床应用的精细化管理。

Objective To explore the application value of diagnosis related groups(DRG)technology in clinical application management of antibiotics for inpatients.Methods Inpatients discharged from a tertiary general from April to June 2020 were selected as the study objects.DRG grouping data were obtained from the provincial DRG-based hospital quality management and performance evaluation platform,and antibiotics application data were extracted from the hospital information system of the hospital in question.Based on the DRG group,a descriptive statistical analysis was conducted on the overall situation of antibiotics application and the applications between departments and physicians in different time periods.Results A total of 8263 discharged patients were included,involving 491 groups of DRG,with 4193 of whom treated with antibiotics and 417 groups of DRG involved.The antibiotics use density(AUD)was significantly different among different DRG groups,with the maximum being 290 DDDs/100 person days(EM18C group)and the minimum 0.21 DDDs/100 person days(FM15B group).Analysis of the NS06Z group,which had the largest number of cases from April to June,found that the utilization rate of antibiotics changed little with time.Analysis of the typical case group EM11 A,found that the AUD and utilization rate of antibiotics were too high in some departments and physicians.Some departments and physicians also presented the problem of high rate of combined drug use.Conclusions DRG can scientifically evaluate the clinical application of antibiotics in inpatients,identify the key points of clinical application management of antibiotics in inpatients,and contribute to fine management of clinical application of antibiotics in inpatients.