基于临床病情评估工具的医保支付方式研究——以脓毒症为例

Research on Medical Insurance Payment Methods Based on Clinical Assessment Tools--Taking Sepsis as an Example

目的:提出一种基于患者病情客观严重程度的医保支付方式,进一步提升我国DRG/DIP对严重内科疾病支付的科学性、精准性。方法:以脓毒症为例,根据疾病发展规律和临床资源消耗的内在逻辑,选择恰当的临床病情评估工具(序贯器官衰竭估计评分,SOFA评分),分析医疗费用的影响因素,采用多元线性回归步进法进行回归分析,构建支付模型。结果:SOFA评分与医疗费用显著相关,相关系数为0.786(p<0.001),线性回归模型拟合度良好(单变量R^(2)=0.615,双变量R^(2)=0.732)。结论:根据SOFA评分对脓毒症进行医保支付具有可行性,能够更好适应临床需要、体现医疗价值。

Objective:The paper proposes a payment method based on the severity of patients'conditions to further improve the scientificity and accuracy of DRG/DIP payment for severe internal diseases.Methods:Taking sepsis as an example,appropriate clinical evaluation tools(Sequential Organ Failure Assessment Score,SOFA Score)were selected to analyze the influencing factors of medical expenses based on the development of disease and the internal logic of clinical resource consumption.Stepwise multiple linear regression analysis was used for the regression analysis and construction of payment model.Results:The SOFA score is significantly correlated with medical expenses,with a correlation coefficient of 0.786(p<0.001).The linear regression model fits well,and the R^(2) of univariate is 0.615 and the R^(2) of bivariate is 0.732.Conclusion:Using SOFA score for the medical insurance payment of sepsis is feasible,which can better fit clinical needs and reflect medical value.