陕西省某三甲医院剖宫产病例DRGs分组效果及费用结构分析

An analysis of DRGs grouping effect and cost structure of cesarean section cases in a hospital in Shaanxi province

目的探讨剖宫产病例DRGs细分组效果及费用结构。方法收集陕西某医院2020年1月~2022年6月剖宫产病例的病案首页数据(n=3038),依据CHS-DRG分组方案进行病例组合,分析分组效果和费用标准,以及费用结构情况。结果按照CHS-DRG分组方案将剖宫产划分了4个DRGs组,OB23组病例最多(55.92%),OB21组病例最少(2.17%)。各DRGs组住院费用的CV值为0.2~0.7,RIV为87.92%~98.14%,分组效果较好;不同DRGs组住院费用有统计学差异(χ^(2)=195.41,P<0.01),超标费用病例共177例(5.83%),各组超标费用比例均<10%;不同DRGs组住院费用各项构成比间有统计学差异(P<0.01),耗材费、药品费、麻醉手术费用占比均是不同DRGs组费用构成的前三位。结论剖宫产病例的DRGs细分组较合理,对陕西省建立符合本土情况的剖宫产DRGs细分组方案和标准费用可提供科学的依据和参考;剖宫产住院患者的费用结构仍需优化,强化药品和耗材的合理使用,有效控制医疗费用。

Objective To explore the effect of DRGs subdivision group of cesarean section cases and the cost structure.Methods The data were collected from the first page data of medical records of all caesarean section cases in a hospital in Shaanxi Province from January 2020 to June 2022(n=3038).The case mix is carried out according to the CHS-DRG subdivision group scheme;grouping effect,cost standard and cost structure are analyzed.Results According to the CHS-DRG grouping scheme,cesarean section was divided into four DRGs groups,the OB23 group having the most cases(55.92%)and OB21 group having the least cases(2.17%).The CV value was 0.2~0.7 in each DRGs group,and the RIV was 87.92%~98.14%,so the grouping effect was reasonable.The hospitalization expenses in different DRGs groups were statistically different(χ^(2)=195.41,P<0.01).There were 177 cases(5.83%)with excessive expenses,and the proportion of excessive expenses in each group was less than 10%;the constituent ratios of hospitalization expenses in different DRGs groups were statistically different(P<0.01),and the proportions of consumables,drugs and anesthesia surgery expenses were the top three in the composition of expenses in each group.Conclusion The DRGs subdivision group of cesarean section cases is reasonable,which can provide scientific basis and reference for Shaanxi Province to establish a local DRGs subdivision group scheme and standard costs.The cost structure of inpatients undergoing cesarean section still needs to be optimized,and the rational use of drugs and consumables should be strengthened to effectively control medical expenses.