DRG付费下胃癌手术患者感染防控的成本效益分析

Cost-benefit Analysis of Infection Prevention and Control in Patients Undergoing Surgery for Gastric Carcinoma under DRG Medical Insurance Payment Method

目的:评估胃癌术后感染的经济负担,分析胃癌术后感染预防与控制措施的成本效益。方法:回顾性分析2022年1月1日至2022年12月31日我院胃外科所有行胃癌手术患者,比较感染组和未感染组各项医疗费用和住院天数。根据患者手术量、住院费用、术后感染率、因发生感染而少收治的患者数和减少的收入,进而推算胃外科院内感染预防与控制措施的成本效益,并对医保费用精细化支付提出建议。结果:感染组平均住院天数为34天,高于未感染组的14天;感染组平均住院总费用为127176.99元,高于未感染组的66161.03元,差异均具有统计学意义,(P<0.05)。若实施胃癌手术院内感染与防控措施,感染发生率降低10%时,效益成本比可达1.15。同时对基于价值医疗精细化付费具有重要探索意义。结论:实施医院感染预防与控制项目,不但可以提高医疗质量减轻患者经济负担,并可增加医院收入,医院感染管理的质量直接对医保费用支付产生重要影响;基于可预防的感染发生率进行DRG支付调整,对现行医保支付政策完善有一定探索价值。

Objective:To study the economic burden of infection after gastric carcinoma surgery,and to analyze the cost-benefit of infection prevention and control after gastric carcinoma surgery.Methods:All patients who underwent gastric carcinoma surgery in gastric surgery department from January 1,2022 to December 31,2022 were retrospectively investigated,and various medical expenses and hospitalization days were compared between the two groups.According to the infection rate,operation volume,hospitalization cost per patient,the number of patients less admitted due to infection and the reduced income,the benefits of the nosocomial infection prevention and control project in gastric surgery department were calculated,and make suggestions on refined payment of medical insurance expenses.Results:The length of hospital stay in the infection group was 34 days,which was higher than that in the non-infection group 14 days,and the difference between the two groups was statistically significant(P<0.05).The total cost of hospitalization in the infection group was 127176.99 yuan,which was higher than 66161.03 yuan in the non-infection group(P<0.05).If the implementation of prevention and control measures for nosocomial infection in gastric cancer surgery,when the incidence of infection is reduced by 10%,the beneficence-cost ratio can reach 1.15.At the same time,it has important exploratory significance for refined value-based medical payment.Conclusion:The implementation of nosocomial infection prevention and control project can not only reduce the financial burden of patients,increase the income of the hospital.The quality of hospital infection management directly has an important impact on medical insurance payment;adjusting DRG payment based on the incidence of preventable infections has certain exploratory value in improving the current medical insurance payment policy.