DRG支付下甲状腺大手术患者住院费用影响因素研究

Study on the influencing factors of hospitalization expenses of patients undergoing major thyroid surgery under DRG payment

[目的]探讨某院甲状腺大手术患者住院费用的影响因素,为疾病诊断相关分组(DRG)细化分组和住院费用控制提供参考。[方法]根据医院2022年1-10月医保DRG系统的分组结果,收集乳腺甲状腺外科甲状腺大手术患者住院病例的病案首页信息,采用描述性统计分析患者住院时间、住院费用及费用构成差异;使用单因素分析患者住院费用的相关影响因素;运用结构方程验证各影响因素与住院费用的相关性。[结果]本研究共纳入643名患者,平均住院日为7 d,平均住院费用为19009.57元。以重庆市DRG支付中甲状腺大手术的支付标准为参考,该院乳腺甲状腺外科甲状腺大手术超支病例组患者医疗资源消耗高于正常病例组(P<0.05),显著影响患者的住院费用;单因素分析显示,甲状腺大手术患者住院费用与患者住院时间、手术部位、其他诊断数量、其他手术数量、是否使用机器人辅助操作有关;结构方程显示,住院费用的主要影响因素为是否使用机器人辅助操作,其他影响因素从大到小依次为:其他手术数量、手术部位、住院时间和其他诊断数量。[结论]在DRG支付方式下,甲状腺大手术可参考住院费用的相关影响因素结果,将患者是否使用机器人辅助操作纳入分组标准;同时,积极探索甲状腺大手术的诊疗路径和管理模式,并针对甲状腺疾病患者实施个性化精准健康管理,有利于减少患者住院费用。

Objective To analyze the influencing factors of hospitalization cost of patients undergoing major thyroid surgery,and to provide references for the refinement of Diagnosis Related Groups(DRG)and the control of hospitalization cost.Methods According to the classification results of the hospital s medical insurance DRG system from January to October 2022,information on the first page of medical records of inpatients undergoing major thyroid surgery in the department of breast thyroid surgery was collected.The differences of hospitalization duration,hospitalization cost and cost composition were analyzed by descriptive statistics.The influence factors of hospitalization cost were analyzed by single factor analysis.The correlation between the influencing factors and hospitalization cost was verified by structural equation.Results A total of 643 patients were included in this study,with an average hospital stay of 7days and an average hospitalization cost of 19009.57 yuan.Based on the payment standard of major thyroid surgery in Chongqing DRG payment,patients consumption of medical resource in the over-budget case group of major thyroid surgery in KD19 group of this hospital was higher than that in the normal case group(P<0.05),which significantly affected the hospitalization expenses of patients.Univariate analysis showed that the hospitalization cost of patients undergoing major thyroid surgery in the KD19 group was related to length of hospital stay,surgical site,the number of other diagnosis,the number of other surgeries,and whether robot-assisted surgery was used.The structural equation showed that the main influencing factor of hospitalization cost was whether robot-assisted operation was used.Other influencing factors in descending order were the number of other surgeries,surgical site,length of hospital stay and the number of other diagnosis.Conclusions Under the DRG payment method,mafor thyroid surgery can refer to the results of relevant influencing factors of hospitalization costs,and include whether patients use robot-assisted operation into the classification criteria.At the same time,the diagnosis and treatment path and management mode of major thyroid surgery should be promoted actively.Personalized and accurate health management for patients with thyroid diseases could be implemented,which is conducive to reducing patients hospitalization cost.