医院基于国家医疗保障疾病诊断相关分组费用分段管理研究

Research on expense segment management of CHS-DRG in hospital

目的:研究医院基于国家医疗保障疾病诊断相关分组(CHS-DRG)费用分段管理方法在住院患者医疗费用管理中的应用效果。方法:选取医院经CHS-DRG分组后纳入冠状动脉手术(FC19)病组分布在A、B、C、D、E共5个临床科室中的4223例出院患者住院总费用、住院日数、住院病案首页及医嘱信息数据,其中包括医嘱金额、开单科室及开单医生等数据,获取FC19病组患者住院次均费用、次均药品费用及次均耗材费用等指标数据,对比分析5个临床科室费用超标患者和未超标患者住院次均费用数据,并对科室间患者住院总费用进行分段统计比较。结果:FC19病组中有2019例(占47.81%)患者住院费用超标。A科室整体费用均高于医院平均水平,B科室次均药品费用最低,C科室次均耗材费用最低,D科室次均药品费用最高,E科室整体费用均低于医院平均水平,5个临床科室住院次均费用比较,差异有统计学意义(F=105.37,P<0.05)。结论:CHS-DRG应用于住院患者费用分段管理,能够分析调整患者费用结构,进而加强重点环节科室费用效率管理和绩效考核,实现耗材合理化使用。

Objective:To study the method and application effect of expense segment management of China healthcare security diagnosis related groups(CHS-DRG).Methods:The data about the total hospitalization expenses,number of days of hospitalization,cover page of medical records and medical orders(including amount of medical orders,billing department and billing doctor)of 4,223 patients discharged(in 5 clinical departments,A,B,C,D and E)in the FC19(coronary artery surgery)group after being grouped by CHS-DRG were selected.The index data of average expenses per time,average drug expenses per time and average consumable expenses per time of the patients in FC19 group were obtained.The data of patients with over-standard and non-over-standard expenses,horizontal comparison of patient medical order data between departments,and segmented statistical analysis of patient expenses were compared and analyzed.Results:There were 2019 patients(47.81%)in the FC19 disease group whose hospitalization expenses exceeded the standard.The overall cost of A department is higher than the average level of the hospital,Department B had the lowest drug expenses per time,Department C had the lowest consumable expenses per time,Department D had the highest drug expense per time,and the overall cost of E department is lower than the average level of the hospital.The average cost per hospitalization in 5 clinical departments was compared,and the difference was statistically significant(F=105.37,P<0.05).Conclusion:The application of CHS-DRG in the expense segment management of inpatients can analyze and adjust the structure of patients'expenses,and further strengthen the expense efficiency management and performance appraisal of key departments,and to realize the rational use of consumables.