临床药师基于结构变动度对DRG超支病例用药合理性分析与研究

Analysison the Rational Drug Use of Overspending Cases in the Diagnosis Related Group by Clinical Pharmacists based on Structural Variability

目的:结合疾病诊断相关分组(DRG)对医疗机构住院费用超出支付标准的病例进行分析,为促进临床合理用药和住院费用精细化管控提供参考。方法:利用三级甲等综合性医院病案信息系统,基于结构变动度分析法对2021年1~6月住院总费用超出估算支付标准的DRG组别进行费用组成、影响因素及变动情况分析,进一步借助处方医嘱点评手段,对筛选病例开展用药合理性评价。结果:不同DRG组别之间的住院费用结构存在明显差异,通过结构变动贡献率指标可筛选药品费用变动大的超支病例开展处方医嘱点评,同时,临床药师发现超支病例存在不同程度用药问题,主要包括:围手术期预防选用抗菌药物不适宜及用药疗程过长、无适应证用药、用法用量不适宜、肠外营养疗程过长、未首选指南推荐用药等。结论:通过剖析DRG产出的标准化数据,利用结构变动贡献率可“靶标”用药问题,为DRG背景下住院费用精准管控提供新的切入点。

Objective:To analyze the cases of treatment expenditure exceeding the payment standard in our hospital based on the diagnosis related group, which may provide a reference for the improvement of rational drug use and the delicacy management of treatment expenditure. Methods:A systemic analysis on the composition of treatment expenditure, the influencing factors and the range of fluctuation for the overspending cases in the diagnosis related group were performed using the hospital information system from January to June 2021. Furthermore, the rationality of drug use was evaluated for the selected overspending cases by the prescription review. Results:The structure of treatment expenditure in our hospital was obviously difference among the diagnosis related groups, and then the higher rate of structural contribution was used for the screening condition of overspending cases to further carry out prescription review. Meanwhile, some problems of irrational drug use were found by clinical pharmacists, mainly including the inappropriate drug selection and treatment course of antimicrobials during perioperative period, the drug use without indication, the inappropriate drug dosage, the prolonged course of parenteral nutrition, and no recommendation drug by preferred guidelines.Conclusion:The rate of structural contribution on treatment expenditure can be used to target problems of irrational drug use by analyzing the data of diagnosis related group, which providing a new pathway for the delicacy management of treatment expenditure in the hospital under the background of diagnosis related group.