基于DRG风险调整模型的加速康复外科管理效果评价

Evaluation on Effectiveness of Enhanced Recovery After Surgery Based on DRG Risk-Adjusted Model

目的基于疾病诊断相关分组(DRG)风险调整模型,对加速康复外科(Enhanced Recovery After Surgery,ERAS)的管理效果进行评价。方法在CHS-DRG分组基础上建立亚组用于专科精准化分析。以DRG能力评价指标(病例组合指数、权重)、效率评价指标(时间和费用消耗指数)、质量评价指标进行干预前后效果的分析。结果经过规范化ERAS干预,目标治疗组的病例组合指数提升至胸外专业平均水平之上。收治同样的疾病患者时,整体资源消耗(经DRG风险调整后平均住院费用)下降8 002元,术后时间消耗(经DRG风险调整后平均术后住院日)下降1.4天。各DRG亚组的资源和时间消耗均降低,医疗安全指标无明显改变。结论 DRG风险调整模型验证了ERAS在保障安全的前提下对于服务能力及效率提升的贡献,方法可行且可靠。通过DRG风险调整后的评估模型能够有效避免因疾病构成和特点的变化导致的混杂作用,是科学、有效的评价方式。

Objective To evaluate the effectiveness of Enhanced Recovery After Surgery by DRG risk-adjusted model.Methods Based on CHS-DRG,the sub-DRG was introduced as a tool for risk adjustment.Performance evaluation indicators,including Case-mix Index(CMI)and Relative Weight(RW),efficiency rating index(time and cost consumption index)and quality evaluation index,were analyzed.Results By normalized ERAS intervention,the target treatment group achieved rising CMI and RW,while the charge efficiency index and time efficiency index decreased by 8002 yuan and 1.4 days significantly.Index about the medical safety did not change statistically.Conclusion DRG risk-adjusted model verified the contribution of service ability and efficiency under the premise of safeguard,and it is feasibility and reliability.The appraisal model of DRG risk-adjusted model can effectively avoid the confounding function caused by potential disease distribution and the characteristics,so it is scientific and effective.