摘要
目的探讨疾病诊断相关分组(DRGs)付费模式在危重患者中的应用效果及其对疾病康复进程、住院费用的影响。方法收集2018年1月—2021年1月广元市中心医院收治的4362例危重患者病案数据,将2018年1月—2019年1月实施常规付费模式的2146例危重患者作为对照组,将2019年2月—2021年1月实施DRGs付费模式的2216例危重患者作为观察组。分析两组病种数量、手术种类数量、平均住院时间、平均住院费用、收治能力等指标,进一步分析DRGs付费模式对危重患者总费用的影响路径。结果①两组诊疗费相比,差异无统计学意义(P>0.05);观察组手术费、药品费、耗材费、检查费及人均住院费均低于对照组(P<0.05);②观察组手术台数多于对照组(P<0.05),两组各级手术占比相比,差异无统计学意义(P>0.05);③观察组C型病例、D型病例的收治能力均高于对照组,住院时间短于对照组,差异有统计学意义(P<0.05);④观察组ES10呼吸系统炎症/感染、BR25脑血管疾病、GU23消化系统疾病、FT23高血压危象、ET13慢性阻塞性肺疾病急性期(AECOPD)、DS19严重肢体损伤诊治占比明显高于对照组,差异有统计学意义(P<0.05);⑤观察组ES10呼吸系统炎症/感染、BR25脑血管疾病、GU23消化系统疾病、FT23高血压危象、ET13 AECOPD、DS19严重肢体损伤平均住院费用低于对照组,差异有统计学意义(P<0.05);⑥结构等式模型对总费用影响因素进行路径分析,结构等式模型中DRGs付费模式对药费、检查费、耗材费的直接效应差异均有统计学意义(P<0.05),DRGs付费模式对手术费、诊疗费的直接效应差异不具统计学意义(P>0.05);DRGs付费模式对总费用的间接效应值=2432.36,直接效应值=283.47。结论DRGs付费模式的应用有助于医院成本管理,提高危重患者收治能力,同时该模式可通过降低药费、检查费、手术费减少患者医疗费用,以减轻患者经济负担。
Objective To investigate the application effect of the payment model of disease diagnosis-related groups(DRGs)in critically ill patients and its impact on the disease recovery process and hospitalization expenses.Methods Collect the medical record data of 4362 critically ill patients admitted to our hospital from January 2018 to January 2021.The 2146 critically ill patients who implemented the conventional payment model between January 2018 and January 2019 were used as the control group.2216 critically ill patients who implemented the DRGs payment model from February to January 2021 were used as the observation group.Analyze the number of diseases in the two groups,the number of types of operations,the average length of stay,the average cost of hospitalization,and the ability to receive treatment,and further analyze the influence path of the DRGs payment model on the total cost of critically ill patients.Results①There was no statistically significant difference between the two groups of diagnosis and treatment expenses(P>0.05);the observation group's surgical expenses,medicine expenses,consumables,examination expenses and per capita hospitalization expenses were lower than those of the control group(P<0.05);②The observation group had more operating tables than the control group(P<0.05),and there was no statistically significant difference in the proportions of operations at all levels between the two groups(P>0.05);③The admission and treatment capacity of type C and type D cases in the observation group was higher than that of the control group,and the hospital stay was shorter than that of the control group,the difference was sta⁃tistically significant(P<0.05);④Observation group ES10 respiratory system inflammation/infection,BR25 cerebrovascular disease,GU23 digestive system disease,FT23 hypertensive crisis,ET13 chronic obstructive pulmonary disease(AECO⁃PD),DS19 severe limb injury diagnosis and treatment accounted for significantly higher proportions In the control group,the difference was statistically significant(P<0.05);⑤The average hospitalization cost of ES10 respiratory system inflam⁃mation/infection,BR25 cerebrovascular disease,GU23 digestive system disease,FT23 hypertensive crisis,ET13 AECO⁃PD,DS19 severe limb injury in the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05);⑥The structural equation model conducts a path analysis of the factors affecting the total cost.The direct effects of the DRGs payment model on the drug,inspection,and consumable costs in the structural equa⁃tion model are all statistically significant(P<0.05).The direct effect difference of DRGs payment mode on operation cost and diagnosis and treatment cost is not statistically significant(P>0.05);the indirect effect value of the DRGs payment model on the total cost=2432.36,and the direct effect value=283.47.Conclusion The application of the DRGs payment model is helpful for hospital cost management and improving the ability to admit and treat critically ill patients.At the same time,this model can reduce the medical expenses of patients by reducing the cost of medicine,inspection and sur⁃gery,so as to reduce the economic burden of patients.
作者
张琳
王琼莲
欧红梅
唐兵
ZHANG Lin;WANG Qionglian;OU Hongmei;TANG Bing(Guangyuan Central Hospital,Guangyuan Sichuan 628000,China)
出处
《中国急救复苏与灾害医学杂志》
2022年第11期1520-1524,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
2016年四川省卫生和计划生育科研课题资助项目(编号:16PJ153)。
关键词
付费模式
疾病康复进程
危重患者
住院费用
病种数量
Payment model
Disease recovery process
Critically ill patients
Hospitalization expenses
Number of diseases