疾病诊断相关分组预定额付费制下不同年龄组患者费用调整模型研究

Study on the cost adjustment model for patients of different age groups under the diagnosis-related group prospective payment system

目的探索依据年龄系数调整费用模型,使其更符合临床实际资源消耗,缓解疾病诊断相关分组预定额付费制(DRG-PPS)付费后可能出现的针对老年患者的问题。方法纳入本院2022全年出院患者的数据,根据年龄(青中年组、初老组、高龄老年组)和诊断相关分组(DRG)费率公式计算出不同年龄组病例费率系数,以此调整费用支付标准。首先运用SPSS软件中配对t检验的方法来判断实际费用与现行费用支付标准差值和实际费用与年龄权重调整后的费用支付标准差值的统计学意义(组内差异)。其次运用Wilcoxon秩和检验来判断实际费用与现行费用支付标准差值同实际费用与调整后费用标准差值的统计学意义(组间差异)。最后,为了研究年龄系数调整模型的适用性,选择了11个病组,使用Wilcoxon秩和检验判断调整前后两组之间是否存在统计学差异,并使用标准差判断调整是否有效。结果实际住院费用与现行标准(组1)的差值、实际住院费用与调整费用支付标准(组2)的差值分别差异无统计学意义(P=0.928、0.949)。两组数据纳入秩和检验统计分析结果为两组数据组间差异有统计学意义(P<0.05)。组1的中位数为-1644.57,均值为-999.04,均值的标准误为70.35,标准差为15024.62,组2的中位数为-1641.88,均值为-998.50,均值的标准误为70.32,标准差为15019.24。结论现行和调整后的标准都能反映患者实际住院费用,但调整后的标准与实际费用更接近,模型有效。

Objective To explore the cost adjustment model based on age coefficient and to make the payment standard more consistent with the actual resource consumption in clinical settings partially address the issue of targeting elderly patients that may arise after the implementation of DRG-PPS payment.Methods The study analyzed data from all discharged patients in a hospital in 2022.Case rate coefficients were calculated for different age groups(young-middle-aged group,early elderly group,and high-aged elderly group)using the DRG(Diagnosis-related Group)rate formula to adjust the payment standard.The statistical significance of the difference between the actual cost and the current payment standard(within-group difference)was determined using the paired t-test in SPSS software.The Wilcoxon rank sum test was then used to determine the statistical significance of the difference between the actual cost and the adjusted payment standard(between-group difference).To assess the applicability of the age coefficient adjustment model,11 disease groups were selected,and the Wilcoxon rank sum test was used to determine if there was a statistical difference between the adjusted and non-adjusted groups.The effectiveness of the adjustment was judged based on the standard deviation.Results There was no significant difference between the actual hospitalization costs and the current standards(Group 1)and the actual hospitalization costs and the adjusted payment standards(Group 2)(P values were 0.928 and 0.949,both greater than or equal to 0.05).The results of the rank sum test showed a statistical difference between the two groups(P value of less than 0.05).Group 1 had a median of-1644.57,a mean of-999.04,a mean standard error of 70.35,and a standard deviation of 15024.62.Group 2 had a median of-1641.88,a mean of-998.50,a mean standard error of 70.32,and a standard deviation of 15019.24.Conclusions Both the current and adjusted rates accurately reflect the true cost of hospitalization for patients.However,the adjusted standard is more closely aligned with the actual costs and the model remains valid.partially address the issue of targeting elderly patients that may arise after the implementation of DRG-PPS payment.