疾病诊断相关分组付费方式对西安市视神经脊髓炎谱系疾病住院医保患者诊疗的影响及其完善策略

The impact of disease-related group payment methods on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders in Xi'an and its improvement strategy

目的初步探讨疾病诊断相关分组(DRG)付费方式对视神经脊髓炎谱系疾病(NMOSD)住院医保患者诊疗的影响及其完善策略。方法单中心、回顾性研究。2020年10月1日至2022年9月30日于西北大学附属第一医院(西安市第一医院)神经眼科检查确诊并住院治疗的急性期NMOSD的医保患者44例纳入研究。其中,男性11例,女性33例;年龄(40.8±20.2)岁。根据DRG付费实施时间,将患者分为2020年10月1日至2021年9月30日DRG付费实施前1年组(A组)、2021年10月1日至2022年9月30日DRG付费实施后1年组(B组),分别为20、24例。详细收集两组患者住院时间、治疗方式、住院费用等信息。对比分析两组患者住院费用及治疗方式对费用的影响。组间正态分布数据比较采用t检验,组间偏态分布数据比较采用Mann-Whitney U检验。结果44例患者中,接受血浆置换(PE)治疗者5例(5/24,20.8%),均为B组患者。接受、未接受静脉注射免疫球蛋白(IVIG)治疗者,A组分别为9、11例;B组分别为7、12例(5例接受PE治疗者除外)。与A组比较,B组患者住院时间(t=0.004)及住院总费用(Z=0.036)、西药费(Z=0.036)、检查费(Z=0.011)、检验费(Z=0.040)、治疗费(Z=0.017)、护理费(Z=3.131)均未明显下降,差异无统计学意义(P>0.05)。行PE治疗的患者除西药费(Z=0.062,P=0.804)外,其余费用(Z=8.288、5.013、11.400、10.925、9.126)均较未接受PE治疗患者明显增高且住院时间(t=20.474)显著延长,差异有统计学意义(P<0.05)。A组、B组患者中,接受IVIG治疗者住院总费用较未接受IVIG治疗者显著增加,差异有统计学意义(Z=7.690、10.314,P<0.05)。A组、B组接受IVIG治疗者间住院总费用比较,差异无统计学意义(Z=0.137,P>0.05)。结论西安市NMOSD住院医保患者各项住院费用在实施DRG付费后未出现明显下降,尤其是采用PE治疗者;建议实施DRG付费方式时,优化NMOSD患者费率分层。

Objective To preliminary investigate the impact of the diagnosis-related groups(DRG)payment method reform on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders(NMOSD),and to propose potential improvement strategies.Methods A single-center,retrospective study.From October 1,2020,to September 30,2022,44 hospitalized medical insurance patients with acute-phase NMOSD diagnosed and treated at the First Affiliated Hospital of Northwest University(Xi'an First Hospital)were included in the study.Among them,there were 11 males and 33 females,with an average age of(40.8±20.2)years.According to the implementation time of DRG payment,patients were divided into two groups:group A,which consists of cases one year before the implementation of DRG payment from October 1,2020 to September 30,2021,and group B,which consists of cases one year after the implementation of DRG payment from October 1,2021 to September 30,2022,with 20 and 24 cases,respectively.Detailed information such as hospitalization duration,treatment methods,and hospitalization costs of the two groups of patients was collected.Comparative analysis was conducted on hospitalization costs and treatment methods between the two groups.For intergroup comparison,t-test was used for normally distributed data,and Mann-Whitney U test was used for skewed distributed data.Results Among the 44 patients,5 cases(5/24,20.8%)received plasma exchange(PE)treatment,all of whom were in group B.The numbers of patients who received and did not receive intravenous immunoglobulin(IVIG)treatment were 9 and 11 in group A,respectively,and 7 and 12 in group B(except for 5 cases who received PE treatment),respectively.Compared with group A,there was no significant decrease in hospitalization duration(t=0.004)and total hospitalization costs(Z=0.036),as well as costs for western medicine(Z=0.036),examinations(Z=0.011),laboratory tests(Z=0.040),treatments(Z=0.017),and nursing(Z=3.131)in group B,and the differences were not statistically significant(P>0.05).For patients receiving PE treatment,except for the cost of western medicine(Z=0.062,P=0.804),the other costs(Z=8.288,5.013,11.400,10.925,9.126)were significantly higher than those of patients not receiving PE treatment,and the hospitalization duration(t=20.474)was significantly prolonged,with statistically significant differences(P<0.05).The total hospitalization costs of patients receiving IVIG treatment were significantly higher than those not receiving IVIG treatment in both group A and group B,with statistically significant differences(Z=7.690,10.314;P<0.05).There was no statistically significant difference in the comparison of total hospitalization costs between patients receiving IVIG treatment in group A and group B(Z=0.137,P>0.05).Conclusions There is no significant decrease in various hospitalization costs of NMOSD medical insurance patients in Xi'an after the implementation of DRG payment,especially for patients receiving PE treatment.It is suggested to optimize the rate stratification of NMOSD patients when implementing DRG payment methods.