DRG支付背景下2型糖尿病患者实施临床路径管理的效果分析

Effect Analysis of Clinical Pathway Management in Patients with Type 2 Diabetesin The Context of DRG Payment

目的:对实施临床路径管理的2型糖尿病患者住院病案信息进行分析,为DRG付费实施提供管理思路和应对措施。方法:采用回顾性分析研究方法,对南京市某三级老年医院2019年1月1日-2021年12月31日期间出院的2型糖尿病患者住院病案首页数据进行分析,并进一步分析实施临床路径管理的2型糖尿病患者住院总费用和住院天数的主要影响因素。结果:实施临床路径管理患者住院总费用和住院天数均低于未实施临床路径患者。实施临床路径管理患者中,并发症越多,患者住院总费用越高,住院天数越长。住院总费用的多元回归分析结果显示,合并症数量、并发症、住院天数对住院总费用的影响差别有统计学意义。结论:2型糖尿病患者实施临床路径管理,对医院应对DRG付费起到助力作用,要积极推广糖尿病多学科联合诊疗,对糖尿病并发症和合并症进行早期干预,规范诊断和病案首页填写,提高病案内涵质量。根据DRG分组情况调整和细化临床路径管理病种,尽可能覆盖全部DRG分组病种。医务人员要提高费用控制意识,降低药费比重,并运用信息化手段,加强对路径的日常监管。

Objective:Through analyzing the hospitalization medical record information of patients with type 2 diabetes implement⁃ed by clinical pathway management,this paper provides management ideas and Countermeasures for the implementation of DRG pay⁃ment.Methods:A retrospective analysis was conducted to analyze the first page data of hospitalized patients with type 2 diabetes dis⁃charged from a certain tertiary geriatric hospital in Nanjing in January 1,2019-2021 in December 31st,and to further analyze the main influencing factors of total hospitalization expenses and length of stay in type 2 diabetic patients with clinical pathway management.Results:The total hospitalization expenses and hospitalization days of patients in clinical pathway management were lower than those in patients without clinical pathway.Among the patients who implemented the clinical pathway,the more complications,the higher the total cost and the longer the length of stay.The results of multiple regression analysis showed that the number of complications,compli⁃cations and length of stay had significant differences on the total cost of hospitalization.Conclusion:The implementation of clinical pathway management for patients with type 2 diabetes can help hospitals cope with the DRG payment.We should actively promote the multi-disciplinary joint diagnosis and treatment of diabetes,intervene early in diabetic complications and complications,standardize the diagnosis and fill in the front page of medical records,and improve the quality of medical records.Adjust and refine clinical path⁃way management diseases according to DRG grouping,and cover all DRG grouping diseases as much as possible.Medical staff should improve the awareness of cost control,reduce the proportion of drug costs,and use information means to strengthen the daily supervi⁃sion of the path.