公立医院基于DRGs的精细化费用管理探索——结合临床路径的费用结构分析

Exploration of refined cost management in public hospitals based on DRGs--cost structure analysis combined with clinical pathway

为推广实施DRG付费、优化临床路径管理、提高优质医疗资源配置效率、实现精细化成本管控提供参考,对广东省某三甲综合医院2019年的患者病案首页进行DRG分组,每组按照入径与否进行分类,运用结构变动度和增量贡献率评价住院费用结构变化的特征,分析不同DRG分组患者临床路径的管理与住院费用结构情况。发现用于分析的DRG病种总体治疗费(20%以下)和综合医疗服务费(10%以下)占比偏低;部分DRG病种(如WB23)入临床路径能够在耗材、诊断和药品等项目上有效控制住院费用,但仍有部分DRG病种(如FE15)的临床路径管理有待优化,样本医院能够为这部分病种患者提供更低的耗材类费用或诊断费。建议重视病案首页信息填写,加强病案信息化建设;进一步优化费用结构,体现医务人员劳动技术价值;重视DRG病种与临床路径的深度应用,实现精细化成本管控;进一步实现临床路径与DRG的有机统一,共同提高优质医疗资源配置效率。

The paper provides a reference for promoting DRG payment,optimizing clinical pathway management,improving the allocation efficiency of high-quality medical resources and realizing refined cost control.In this paper,the first pages of patients medical records in a tertiary general hospital in Guangdong Province in 2019 are divided into DRG groups.Each group is classified according to the entry of clinical pathway.Degree of structure variation and contribution rate of increment are used to evaluate the characteristics of the structural change of hospitalization expenses,and analyze management of clinical pathway and structure of hospitalization expenses in different DRG groups.It is found that the total treatment cost(less than 20%)and comprehensive medical service cost(less than 10%)of DRG diseases used for analysis account for a relatively low proportion.Some DRG diseases(such as WB23)of clinical entry can effectively control hospitalization cost in items such as consumables,diagnosis and drugs.However,the clinical pathway management of some DRG diseases(such as FE15)still needs to be optimized,and the sample hospital can provide lower costs of consumables or diagnosis for patients with these diseases.It is suggested to attach importance to filling in the information of the first page of medical records and strengthen the information construction of medical records;further optimize the cost structure to reflect the labor and technical value of medical personnel;attach importance to the in-depth application of DRG diseases and clinical pathway to realize refined cost control;further realize the organic unity of clinical pathway and DRG to jointly improve the allocation efficiency of high-quality medical resources.