数据驱动的DRG-DIP-临床路径多维融合分析评价

Data-driven DRG-DIP-clinical pathway multidimensional fusion analysis and evaluation

目的分析疾病诊断相关分组(DRG)、病种分值付费(DIP)两套病种组合体系的入组和权重关联性,应用DRG、DIP、临床路径建立一种多维融合分析评价模式。方法对某三级甲等综合医院2019年出院患者分别实施DRG分组和DIP模拟全量入组,综合运用χ2检验、Pearson相关性分析、t检验、结构变动值、结构变动度、增量贡献率等方法,进行DRG、DIP、临床路径入组(入径)的关联性分析,DRG病组相对权重与DIP标准分值相关性分析,以及两套病种组合体系的临床路径入径情况与费用结构相关性分析。结果130395例出院患者中,进入临床路径者41460例,DRG入组者127535例,DIP入组者104227例。DRG、DIP、临床路径是否入组(入径)两两之间具有相关性(P<0.05),DRG病种相对权重高低与临床路径入组与否也具有相关性(P<0.05);DRG病组相对权重与DIP标准分值呈正相关(r2=0.7617,P<0.001);部分病种临床路径入径与不入径患者的住院费用比较差异有统计学意义(P<0.05),且不同的费用类别对总费用的影响不同。结论DRG与DIP病种权重赋值、价值导向整体一致,构建DRG-DIP-临床路径多维融合评价模式具备可行性。DRG、DIP、临床路径的关联分析可作为病种分类、费用结构评价的依据,有助于更全面、客观、科学地进行医院精细化管理,优化病种结构。

Objective To analyze the correlation between the grouping and weighting of two sets of disease combination systems,namely diagnosis-related groups(DRG)and diagnosis-intervention packet(DIP),and to establish a multidimensional analysis and evaluation mode by applying DRG,DIP,and clinical pathway to guide the standardized diagnosis and treatment and management of disease types.Methods DRG grouping and DIP simulation full enrollment were applied to patients discharged from a tertiary Grade A general hospital in 2019.The correlation analysis between DRG,DIP,and clinical pathway inclusion(entry),correlation analysis between relative weight of DRG group and DIP standard score,and correlation analysis between clinical pathway entry and cost structure of the two disease groups were conducted by using chi-square test,Pearson correlation analysis,t-test,structural change value,degree of structural change,and incremental contribution rate.Results Among the 130395 patients,41460 cases entered the clinical pathway,127535 cases were enrolled in DRG,and 104227 cases were enrolled in DIP.There was a correlation between the enrollment of DRG,DIP,and clinical pathway(P<0.05),and there was also a correlation between the relative weight of DRG groups and the enrollment of clinical pathway.The relative weight of the DRG disease group was positively correlated with the DIP standard score(r2=0.7617,P<0.001).There was a significant difference in hospitalization costs between patients with and without clinical pathway access for some diseases(P<0.05),and different cost categories had different impacts on the total costs.Conclusions The weight assignment and value orientation of DRG and DIP disease types are consistent,and the multi-dimensional fusion evaluation mode for DRG-DIP-clinical pathway is feasible.The correlation analysis of DRG,DIP,and clinical pathways can serve as the basis for disease classification and cost structure evaluation,which could help to carry out hospital′s refined management and optimize disease structure.