CHS-DRG精神疾病分组方案及改进研究

Study on CHS-DRG Mental Illness Grouping Scheme and Its Improvement

目的对CHS-DRG精神疾病分组方案中改良电休克治疗(MECT)进行研究,为北京市医保完善精神疾病分组提供政策建议。方法依据有无改良电休克治疗将5个病组分为MECT组和非MECT组,分析患者住院和费用数据,采用两独立样本t检验、Wilcoxon秩和检验对数据进行统计学检验,以双侧p<0.05为差异具有统计学意义。结果MECT组的住院天数、总费用、药费、检查费、治疗费、其他费用均高于非MECT组,且差别具有统计学意义(p<0.05)。结论建议将改良电休克治疗纳入CHS-DRG相关病例分组方案,提高改良电休克治疗组的权重系数,增加支付标准。建立谈判机制,动态调整CHS-DRG的分组规则,充分发挥CHS-DRG支付方式对规范诊疗行为、合理控制医疗费用、提高医疗质量、效率的引导作用。

Objective To study the modified electroconvulsive therapy(MECT)in the CHS-DRG grouping scheme for mental disorders,and to provide policy recommendations for improving the mental disorders grouping of medical insurance in Beijing.Methods Five groups were divided into MECT group and non-MECT group according to whether there was modified electroconvulsive therapy.The hospitalization and cost data of the patients were analyzed.Two-independent samplet test and Wilcoxon rank sum test were used to statistically test the data.p<0.05 was considered statistically significant.Results The hospitalization days,total costs,drug costs,examination costs,treatment costs,and other costs in the MECT group were higher than those in the non-MECT group,and the dfferences were statistically significant(p<0.05).Conclusion It is suggested that modified electroconvulsive therapy should be included in the CHS-DRG related case grouping scheme,the weight coefficient of modified electroconvulsive therapy group as well as payment standard should be increased.Establish a negotiation mechanism,dynamically adjust the grouping rules of CHS-DRG,and give fllplay to the guiding role of CHS-DRG payment method in standardizing diagnosis and treatment behavior,reasonably controlling medical expenses,and improving medical quality and efficiency.