冠脉支架集采对经皮冠状动脉介入病种的影响分析

Analysis of Influence of Coronary Stent Centralized Procurement on Disease Groups of Percutaneous Coronary Intervention

目的:分析国家组织冠脉支架集中带量采购(以下简称“冠脉支架集采”)对经皮冠状动脉介入病种的影响。方法:利用疾病诊断相关分组对4家医院的经皮冠状动脉介入病种的病案首页数据进行研究,分析冠脉支架集采前后病种费用、平均住院日、手术操作的变化。结果:冠脉支架集采后(2021年1月-11月)较集采前(2020年1月-11月),平均住院日下降12.26%,住院均费下降29.69%,材料费用下降44.47%,药品、检查、检验费用也下降,医疗服务费用有所增长。采用冠脉支架植入术的占比从集采前的86.24%显著降至78.61%(P<0.05),支架植入术式人头比从93.32%下降至84.35%(P<0.05),普通球囊术式人头比从82.95%增加至87.45%(P<0.05),药物球囊术式人头比略有增长但无统计学变化差异。结论:冠脉支架集采后经皮冠状动脉介入病种费用大幅下降,不同医院间费用结构、手术操作方式存在差异,建议医院在DRG付费背景下不断优化病种费用结构,促进医院良性发展。

Objective:The paper analyzes the influence of coronary stent national centralized procurement on disease groups of percutaneous coronary intervention.Methods:According to the first page of percutaneous coronary intervention in four hospitals,the changes of disease cost,average hospitalization days and surgical operation before and after coronary stent centralized procurement were analyzed.Results:The average hospitalization days decreased by 12.26%,the average cost of hospitalization decreased by 29.69%,the cost of materials decreased by 44.47%,the cost of drugs,examination and inspection also decreased,and the cost of medical services increased.The proportion of coronary stent implantation decreased significantly from 86.24%to 78.61%(P﹤0.05),the ratio of stent implantation decreased from 93.32%to 84.35%(P﹤0.05),and the ratio of ordinary balloon operation increased from 82.95%to 87.45%(P﹤0.05).The ratio of drug balloon operation increased slightly,but there was no significant difference.Conclusion:After coronary stent procurement,the cost of percutaneous coronary intervention has decreased significantly,and there are differences in the cost structure and operation methods among different hospitals.It is recommended that hospitals continuously optimize the cost structure of diseases under the background of DRG payment,so as to promote the healthy development of hospitals.