DRG付费下医院感染与医院资源消耗相关分析

Association between nosocomial infection under DRG-based payment and consumption of hospital resources

目的分析疾病诊断相关分组(DRG)付费下医院感染对医院资源消耗的影响。方法基于国家医疗保障疾病诊断相关分组(CHS-DRG 1.1版),将2015-2020年某医院住院患者进行分组,使用时间消耗指数、费用消耗指数等指标对发生医院感染组和非感染组的资源消耗进行描述性统计分析和统计检验。结果纳入分析的463529份病例中,医院感染病例4076份;AH11(有创呼吸机支持≥96小时或ECMO或全人工心脏移植术,伴严重并发症或合并症)的医院感染发生率最高;感染组的费用消耗指数和时间消耗指数(2.31、2.24)远高于非感染组(0.96、0.88),比较差异有统计学意义(P<0.05);肺炎、败血症、无症状菌尿症对资源消耗的影响最大;在ES31(呼吸系统感染/炎症,伴严重并发症或合并症)、AH11、BR23(脑缺血性疾患,伴并发症或合并症)三个DRG中,感染组的平均住院日、时间消耗指数、次均费用和费用消耗指数均高于非感染组(P<0.05);在各类别费用中,药费是导致感染组次均费用高的主要因素,其中主要是抗菌药物费。结论DRG可以帮助确定感染防控的重点病组,加强感染防控,可以有效缩短平均住院日、降低次均费用,从而改善DRG付费下医院的运行状况。

OBJECTIVE To observe the impact of nosocomial infection under diagnosis related grouping(DRG)-based payment system on the consumption of hospital resources.METHODS The patients who were hospitalized in a hospital from 2015 to 2020 were grouped based on CHS-DRG(V1.1).Descriptive statistical analysis and statis-tical test were performed for the consumption of resources of the infection group and the non-infection group by u-sing time consumption index and cost consumption index.RESULTS Of 463529 cases that were enrolled in the study,4076 had nosocomial infection.The incidence of nosocomial infection was the highest among the AH11 pa-tients(with invasive ventilator support no less than 96 hours,ECMO or total artificial heart transplantation,se-vere complications or comorbidities).The cost consumption index and time consumption index of the infection group(2.31,2.24)were significantly higher than those of the non-infection group(0.96,0.88)(P<0.05).Pneumonia,sepsis and asymptomatic bacteriuria had the greatest impact on the consumption of resources.Among the three DRGs ES31(respiratory system infection/inflammation,severe complications or comorbidities),AH11,BR23(cerebral ischemia,complications or comorbidities),the average length of hospital stay,time con-sumption index,average cost and cost consumption index of the infection group were higher than those of the non-infection group(P<0.05).Among the types of costs,drug expense was the leading factor for high average cost of the infection group,which was dominated by cost of antibiotics.CONCLUSION DRG may facilitate the deter-mination of key disease group for prevention and control.Enhancement of the prevention and control of infection can effectively shorten the average length of hospital stay and reduce the average cost so as to improve the opera-tion status of hospitals under DRG-based payment.