DRG付费模式下眼科住院患者病例分组统计分析

Statistical analysis of the case grouping of ophthalmology inpatients in the DRG payment model

目的基于疾病诊断相关分组(Diagnosis Related Groups,DRG)付费模式对医院眼科住院病例进行统计分析,对眼科有关DRG细分组方案提出建设性意见。方法通过国家医疗保障疾病诊断相关分组(CHS-DRG)细分方案(1.0版)进行分组,采集医院眼科DRG付费结算RW、CMI值、组数等指标进行比较分析。结果按DRG付费的出院病例862例,DRG组数16组,总权重804.48,CMI值0.94,RW值≥0.80为465例,占比53.94%,其中有108例治疗青光眼疾病的病例,疾病分组和手术分组均不能体现出治疗的难易程度和危重差异。结论眼科住院收治以玻璃体、视网膜等疑难复杂手术为主,DRG相关指标反映的结果较为客观和科学,但对于青光眼手术患者,建议能对分组方案做适当调整,并确定相应的权重(RW)付费,让不同的医疗价值在权重里得到充分体现。

Objective Statistical analysis of hospital ophthalmology inpatients based on the DRG payment model and constructive opinions on the ophthalmology-related DRG subdivision group scheme were proposed.Method Grouped by the China Healthcare Securi⁃ty Diagnosis Related Grouping(CHS-DRG)subdivision scheme(version 1.0),it collects indicators such as DRG payment settlement RW,CMI value,number of groups in hospital ophthalmology department for comparative analysis.Results There were 862 discharged cases paid by DRG.The number of DRG groups was 16,the total weight was 804.48,the CMI value was 0.94,and the RW value≥0.80 was 465,accounting for 53.94%.Among them,there are 108 cases of treatment for glaucoma,neither the disease group nor the surgical group can reflect the difference in the degree of difficulty and criticality of the treatment.Conclusion Ophthalmology hospitalization is dominated by difficult and complex procedures such as vitreous and retina surgeries,and the results reflected by DRG related indicators are more objective and scientific.However,for glaucoma surgery patients,it is recommended that the grouping scheme can be adjusted appropriately and the corresponding weighting(RW)be determined,so that different medical values can be fully reflected in the weight.