天津市某三级甲等中医医院带状疱疹出院患者费用与DRG分组分析

Study oncost and DRG of discharged patients with herpes zoster in agrade-A tertiary TCM hospital of Tianjin

目的为抑制我国医疗费用快速上涨,各地医保部门采用按疾病诊断相关分组(diagnosis related groups,DRGs)付费方式的尝试。目前天津市正处于各医院就自己优势病种的权重与医保部门进行谈判时期。本研究对带状疱疹出院患者的费用进行分析,希望为医保谈判提供依据。方法采用横断面研究方法和SPSS 24统计软件,通过对2019年1月—2020年12月在天津市某三级甲等中医医院出院的带状疱疹患者出院费用的相关因素进行对比分析,并按医保办提供的DRG分组进行分组,依据天津市基准费用计算出各组的权重。结果入组的出院患者共计1871人,平均年龄[M(P_(25),P_(75))]为65(57,71)岁,平均住院天数为11(9,13)天,平均费用为(13758.22±3545.90)元。在分析影响住院费用的原因时发现,住院费用与住院天数和年龄相关(P<0.01),而与性别无关(P>0.05)。按疾病诊断相关分组分别计算各组的权重。而在使用国家版DRG分组对该院出院患者进行分析时发现,在核心疾病诊断相关分组中(adjacent diagnosis related group,ADRG)中SU1组中ICD-10编码不同的疾病中,播散性带状疱疹(B02.700)和带状疱疹不伴并发症(B02.900)住院费用比较,差异有统计学意义(Z=-8.063,P<0.01)。结论该院数据计算出的权重,在天津市医保部门制定DRG权重时可以作为参考依据。而由于患者随着年龄增加,会增加更多的医疗费用及时间成本,因此医保部门应予以适当的补偿。在对国家版DRG分组研究中,本研究发现个别疾病分组存在歧义,建议将ICD-10编码中B02.700播散性带状疱疹从ADRG中的SU1组改编入JS1组中。

Objective In order to restrain the rapid rise of medical expenses in our country,many medical insurance authorities are trying to adopt payment according to diagnosis related groups(DRGs).Currently,hospitals and medical insurance authoritiesnegotiate the payment weights for various diseases in Tianjin.This paper studies the cost of hospitalized patients with herpes zoster,hoping to provide a basis for negotiation.Methods The cross-sectional study method and SPSS24 statistical software were used to analyze the factors related to the medical expenses of patients with herpes zoster in agrade-A tertiary TCM hospital in Tianjin form January 2019 to December 2020.The patients were grouped according to the DRGS provided by medical insurance institutions,and the weights of each group were calculated according to the baseline costs in Tianjin.Results A total of 1871 discharged patients were enrolled,with an average age[M(P_(25),P_(75))]of 65(57,71)years old.The average length of hospitalization was 11(9,13)days,and the average cost was(13758.22±3545.90)yuan.It was found that the cost of hospitalization was correlated with the length of stay and age(P<0.01),but not with gender(P>0.05).The weights of each group were calculated according to the relevant groups of disease diagnosis.In the study of discharged patients in this hospital using the national version of DRG grouping,it was found that among the diseases with different ICD-10 codes in SU1 Group in the adjacent diagnosis related group(ADRG),there was statistically significant differences in hospitalization costs between disseminated zoster(B02.700)and uncomplicated zoster(B02.900)(Z=-8.063,P<0.01).Conclusions The weight calculated from the data of this hospital can be used as a reference in the formulation of DRG weight by Tianjin medical insurance department.As the patient increases with age,it will cause more medical expenses and time costs,so the medical insurance department should provide appropriate compensation.In the study of the national DRG grouping,the study finds ambiguity in individual disease groups and suggests reprogramming B02.700 disseminated zoster in ICD-10 from SU1 in ADRG into JS1.