医保DRG支付背景下冠状动脉支架置入术病组费用影响因素分析

Analysis of Factors Influencing the Cardiac PCI Grouping Cost based on Medical Insurance’s DRG Payments

目的:规范医院心脏经皮冠状动脉治疗(PCI术)的住院诊疗流程,提高医院管理效益。方法:选取北京市某三级甲等医院2021年1月1日至2021年12月31日实际入组冠状动脉支架置入术(FM19)病组的380份住院病例为研究对象,运用Mann-WhitneyU检验、单因素方差分析、多元线性回归等方法,对住院病案首页信息、医保结算费用明细、住院总费用及影响因素进行分析。结果:有效病例377份,PCI术治疗患者例总费用平均值为46318.21元,与FM19组定额59483元比较,例均定额差结余13164.79元;平均住院天数为6.16天;药占比、手术费占比、治疗费占比对总费用及定额差不产生影响关系,P>0.05。材料占比为影响例总金额与定额差的首要因素,P<0.001。患者自费金额、住院天数与例总金额与组定额差存在负向影响关系,P<0.001。结论:管理医用耗材费用是医疗机构实现冠状动脉支架置入术病组结余的有效举措,规范梳理PCI术住院流程、建立有效的临床路径,同时控制患者自费项目使用是重要手段。

Objective:The paper is to standardize the inpatient diagnosis and treatment process of percutaneous coronary intervention(PCI) and improve hospital management efficiency. Methods: A total of 380patients grouped in FM19 from Jan. 1st 2021 to Dec. 31st 2021 from a first-class hospital in Beijing were analyzed.Mann-whitney U test, one-way ANOVA, multiple linear regression and other methods were used to analyze the factors influencing first page of inpatient medical records and total inpatient expenditure. Results: The per capita cost of 377 effective PCI patients is 46318.21 Yuan pairing with the quota of FM19 which is 59483 Yuan, and the difference value balance is 13184.66 Yuan. Average length of stay is 6.16. Proportion of drugs, operation and treatments are factors which do not have significance of difference value(P>0.05). The primary influencing factor is proportion of medical consumables(P<0.001). Patients’ private expenses and length of stay have negative effect on difference value balance(P<0.001). Conclusion: Managing the cost of medical consumables is an effective measure for medical institutions to realize the balance of patients in PCI group. Standardizing the hospitalization process of PCI, establishing an effective clinical path, and controlling the use of private projects are important means.