基于DRG+疾病风险调整的三级综合医院住院相关费用分析

Analysis of Hospitalization-related Expenses in Tertiary General Hospitals Based on DRG+Disease Risk Adjustment Approach

目的基于DRG+疾病风险调整方法评价河北省三级综合医院住院相关费用,为河北省住院费用指标管控提供科学依据。方法收集河北省2020年1月1日-2020年12月31日省卫建委直属的12所三级综合医院848404条住院病案首页,进行DRG分组,建立疾病风险调整模型,再利用模型对该12所三级综合医院住院费用、医疗服务性收入、药品费用和耗材费用进行预测和评价,并计算DRG指标CMI及调整后住院费用指标。结果经CMI值校正,住院费用中位数最高值的为30681.58元,最低值为10484.77元;医疗服务性收入中位数最高值为12089.59元,最低值为3657.03元;药品费用中位数最高值为9380.54元,最低值为2063.20元;耗材费用中位数最高值为20546.72元,最低值为2344.07元。经过DRG+疾病风险调整方法评价12所三级综合医院,住院费用管控相对较好(O/E≤1)的医院有7所;医疗服务性收入管控相对较好(医疗服务性收入O/E≥1)的医院有3所;药品费用管控相对较好(O/E≤1)的医院有10所,耗材费用管控相对较好(O/E≤1)的医院有3所。结论河北省三级医院间住院费相关费用存在一定差距,耗材费用管控相对较差,基于DRG+疾病风险调整方法评价三级综合医院,有利于医院控费。

Objectives This study aims to evaluate the hospitalization-related expenses in tertiary general hospitals in Hebei province based on the"DRG+disease risk adjustment"approach,so as to provide a scientific basis for the management and control of hospitalization expenses in Hebei Province.Methods 848,404 inpatient medical records from 12 tertiary general hospitals directly under the Provincial Health Construction Commission from January 1,2020 to December 31,2020 in Hebei Province were collected and went through DRG grouping.A disease risk adjustment model was built and reused to predict and evaluate the hospitalization expenses,medical service income,drug expenses and consumable expenses of the 12 tertiary general hospitals.DRG index CMI and adjusted hospitalization expenses index were calculated.Results After CMI correction,the highest value of the median hospitalization expenses was 30681.58 yuan,and the lowest value was 10,484.77 yuan.The highest median value of drug expenses was 9,380.54 yuan,and the lowest value was 2,063.20 yuan.The highest median cost of consumables was 20546.72 yuan,and the lowest was 2344.07 yuan.After evaluating 12 tertiary general hospitals by DRG+disease risk adjustment method,there were 7 hospitals with relatively good hospitalization cost control(O/E≤1),3 hospitals with relatively good control of medical service income(medical service income O/E≥1),and 10 hospitals with relatively good drug cost control(O/E≤1),and 3 hospitals with relatively good consumable cost control(O/E≤1).Conclusions There is a certain gap in hospitalization expenses among tertiary hospitals in Hebei Province,and the control of consumable expenses is relatively poor.The evaluation of tertiary general hospitals based on"DRG+disease risk adjustment"method is beneficial to hospital cost control.