基于DRG数据评价临床路径对风湿免疫科两种疾病医疗效率和医疗费用的影响

Evaluation of the impact of clinical pathway on medical efficiency and medical expenses of patients with two rheumatoid immune disease based on DRG data

目的应用疾病诊断相关分组(DRG)相关指标评价临床路径实施对风湿免疫科两种疾病"类风湿关节炎"和"强直性脊柱炎"患者医疗效率及医疗费用的影响。方法对浙江大学医学院附属金华医院风湿免疫科于2017年1月至2019年12月纳入临床路径管理的两种常见风湿免疫性疾病"类风湿关节炎"和"强直性脊柱炎"患者数据进行分析,比较临床路径实施对该两种疾病患者平均住院时间、均次费用以及均次药费的影响,从而评价临床路径实施的效果。结果自2017年开始实施临床路径至2019年,"类风湿关节炎"和"强直性脊柱炎"两种疾病组收治患者数及医疗专科服务的总工作量均逐年升高。"类风湿关节炎"疾病组患者的平均住院时间、均次费用及均次药费逐年下降,组间比较差异均具有统计学意义(均P<0.01)。"强直性脊柱炎"疾病组平均住院时间逐年缩短,差异具有统计学意义(P<0.01);均次费用方面2018年与2017年相比有明显下降,差异具有统计学意义(P<0.01),2019年与2018年相比差异无统计学意义(P>0.05);均次药费方面2018年与2017年相比有明显升高(P<0.01),通过分析原因并优化临床路径后2019年与2018年相比均次药费降低(P<0.01)。结论通过临床路径的实施并在使用过程中不断优化路径内涵可明显提高对"类风湿关节炎"及"强直性脊柱炎"患者诊治效率,并降低医疗费用,符合目前医改需求。

Objective To evaluate the effect of clinical pathway implementation on medical efficiency and medical expenses of patients with two common rheumatic immune diseases"rheumatoid arthritis"and"ankylosing spondylitis"diseases by using diagnosis related group(DRG)related indicators.Methods The data of patients with two common rheumatic immune diseases"rheumatoid arthritis"and"ankylosing spondylitis"included in the clinical pathway management from January 2017 to December 2019 in the Department of Rheumatology and Immunology of Jinhua Hospital,Zhejiang University School of Medicine were carried out.The impact of clinical pathway implementation on the average hospital stay,average cost and average drug cost of patients with the two diseases were analyzed and compared,so as to evaluate the effect of the implementation of the clinical pathway.Results From the implementation of clinical pathway in 2017 to 2019,the number of patients admitted and total medical specialty services in the two groups of"rheumatoid arthritis"and"ankylosing spondylitis"increased year by year(P<0.01).The average length of stay,average cost and average drug cost of patients in the"rheumatoid arthritis"disease group decreased year by year,with statistically significant differences between groups(all P<0.01).The average length of stay in the ankylosing spondylitis group was shortened year by year,and the difference was statistically significant(P<0.01).Compared with 2017,the average cost in 2018 decreased significantly,and the difference was statistically significant(P<0.01).There was no significant difference in average cost between 2018 and 2019(P>0.05).The average cost in 2018 was significantly higher than that in 2017(P<0.05).After analyzing the causes and optimizing the clinical pathway,the average cost in 2019 was significantly lower than that in 2018(P<0.01).Conclusions Through the implementation of clinical pathways and continuous optimization of pathway connotation during use,the diagnosis and treatment efficiency of patients with"rheumatoid arthritis"and"ankylosing spondylitis"can be significantly improved,and medical costs can be reduced,which is in line with the current medical reform needs.