基于DRG的肺癌患者住院费用结构分析及相关影响因素探讨

Hospitalization Cost Structure and Its Influencing Factors of Lung Cancer Patients Based on DRG

目的:分析以疾病诊断相关分组(diagnosis-related groups,DRG)为基础的肺癌患者住院费用结构及分组效果,并探讨影响肺癌患者住院总费用的相关因素,为进一步开展DRG的成本管理及推广应用提供参考依据。方法:收集某三甲医院2021年1月1日至2022年12月31日期间出院且主要诊断为肺癌(ICD-10:C34)的住院患者的DRG住院信息资料,采用描述性统计方法分析肺癌患者DRG住院费用的构成,采用单因素方差分析评价DRG效果,采用多元线性回归分析筛选影响肺癌住院患者住院费用的相关因素。结果:各DRG住院总费用的变异系数值均小于1,说明组内一致性较好,不同DRG住院总费用进行方差分析显示各分组间差异具有统计学意义(F=22.359,P <0.001),提示DRG效果较好。诊断费、治疗费、药品费和耗材费是肺癌住院费用的主要组成部分,分别占全部费用的28.59%、22.96%、24.23%、18.30%,合计占94.09%,这其中诊断费占比最高;EB19(胸部大手术)分组患者的耗材费占比较高(53.07%),ED11(胸部其他手术伴严重合并症或并发症)患者的药品费占比较高(37.31%)。影响肺癌患者住院总费用的因素依次为:住院天数(P <0.001)、DRG(P <0.001)和年龄(P=0.003),其中住院天数和DRG与住院费用为正相关,年龄为负相关。结论:肺癌DRG效果较好,个别分组还可优化,体现医务人员劳动技术价值的综合医疗服务类费和治疗费占比还需进一步提高,结合住院费用的影响因素进行医疗服务流程优化,为各地进一步推广DRG付费改革提供参考。

Objective:To analyze the structure and effect of hospitalization expenses of lung cancer patients based on diagnosis related groups(DRG),and explore the factors affecting the total hospitalization expenses of lung cancer patients,so as to provide a reference for further cost management and promotion of DRG.Methods:The DRG hospitalization information of inpatients discharged from a level A tertiary hospital from January 1,2021 to December 31,2022 and mainly diagnosed as lung cancer(ICD-10:C34)were collected.The composition of DRG hospitalization cost of lung cancer patients was analyzed by descriptive statistics.The DRG grouping effect was analyzed by one-way ANOVA.And we screened the factors affecting the hospitalization cost of lung cancer patients by multiple linear regression analysis.Results:The coefficient of variation of the total inpatient expenses of each DRG group was less than 1,which indicates that the consistency within groups was good.The variance analysis of the total inpatient expenses of different DRG groups showed that the difference between groups was statistically significant(F=22.359,P 0.001),suggesting that DRG grouping had a good effect.Diagnosis cost,treatment cost,drug cost and consumables cost are the main components of lung cancer hospitalization expenses,accounting for 28.59%,22.96%,24.23%and 18.30%of the total expenses respectively,accounting for 94.09%in total,of which diagnosis cost accounts for the highest proportion.The consumption cost of EB19(major thoracic surgery)group was relatively high(53.07%),and that of ED11(other thoracic surgeries with serious comorbidities or complications)patients was also relatively high(37.31%).The factors that affect the total hospitalization expenses of lung cancer patients were length of stay(P 0.001),DRG grouping(P<0.001)and age(P=0.003).The length of stay and DRG grouping were positively correlated to the hospitalization expenses,while age was negatively correlated to that.Conclusion:DRG grouping for lung cancer has a good effect,and it can be further optimized.The proportions of comprehensive medical service fees and treatment fees that reflect the labor and technical values of medical staff need to be further improved.The medical service process should be optimized based on the influencing factors of hospitalization costs,so as to provide reference for further promotion of DRG payment reform in all regions.