DRGs绩效管理促进心血管内科医保控费成效实践

DRGs Performance Management to Promote the Effective Practice of Cardiovascular Medicine Medical Insurance Cost Control

目的以医院心内科住院病例为案例,对引入按病种付费(diagnosis related groups,DRGs)绩效管理工具加强医保控费效果进行总结分析,以期推广该管理工具。方法选取2020年1月-2021年12月江门市某三级公立医院心血管内科8426名患者,比较使用DRGs前后的医保费用情况,采用秩和检验比较DRGs前后的病种费用。结果心血管内科次均住院费用增长幅度明显降低。其中实施前后不稳定型心绞痛(I20.0)、急性非ST段抬高型心肌梗死(I21.4)、动脉硬化性心脏病(I25.1)、心房颤动和扑动(I48.x)的住院费用比较,差异具有统计学意义,实施后的住院费用低于实施前;实施前后稳定型心绞痛(I20.8)的住院费用比较,差异无统计学意义。结论临床科室利用DRGs绩效管理工具进行精准控费,可提升医保精细化管理水平,促进医疗资源的科学配置。

Objective This study aims to enhance healthcare cost control by introducing diagnosis related groups(DRGs)performance management tools,using inpatient cases in the cardiology department as a case study for summarizing and analyzing cost control outcomes.The goal is to propagate this management approach to other clinical departments within hospitals and other medical facilities in the region.Methods 8426 inpatients in the Department of Cardiovascular Medicine of a tertiary public hospital in Jiangmen City from January 2020 to December 2021 were selected to compare the medical insurance costs before and after the introduction of DRGs.The rank sum test was used to compare the cost of diseases before and after the use of DRGs.Results After the introduction of DRGs performance management tool in the department of cardiovascular medicine,the growth rate of the average hospitalization cost was significantly reduced.The difference in cost for the hospitalization for unstable angina pectoris(I20.0),acute non-ST-segment elevation myocardial infarction(I21.4),arteriosclerotic heart disease(I25.1),atrial fibrillation and flutter(I48.x)before and after implementation were statistically significant.The hospitalization cost after the implementation was lower than that before the implementation.There was no statistically significant difference in hospitalization costs for stable angina pectoris(I20.8)before and after implementation.Conclusion Clinical departments use DRGs performance management tools for accurately expenses control,which will improve the level of refined management of medical insurance and promote the scientific allocation of medical resources.