基于DRG的中医优势病种患者分组效果及住院费用结构分析

Analysis of classification effect and hospitalization cost structure of patients with dominant diseases treated by TCM based on DRG

[目的]分析中医优势病种典型病例的DRG分组效果及患者住院费用结构,为中医医院在DRG支付方式改革下的精细化管理提供参考。[方法]收集2023年湖南省某三甲医院中医优势病种患者病案首页信息,采用变异系数(CV)和整体方差减少系数(RIV)评价DRG分组效果,采用灰色关联模型分析各项费用和总住院费用的关联程度,在时间和组间2个维度上采用结构变动分析法分析各项费用的变动趋势。[结果]DRGs组的总费用和住院天数CV值均小于1,组内同质性较好;DRGs组的住院天数RIV为0.91,组内异质性较优;DRGs组的总住院费用RIV为0.38,组内异质性较差;检验费与患者总住院费用的关联程度最大,耗材费与患者总住院费用的关联程度最小。[结论]医疗资源消耗不均衡,中医优势病种分组效果不佳;各项费用在患者住院总费用中占比不合理,费用变动未充分体现医务人员劳动价值,费用结构待优化;科室具有差异性特征,精细化管理有待加强。

Objective To analyze the classification effect of DRG and the structure of patients hospitalization costs of typical cases of dominant diseases treated by TCM,and to provide the reference for the fine management of Chinese medicine hospitals under the reform of DRG payment methods.Methods The information on the front page of medical records of patients with dominant diseases treated by TCM in a tertiary grade A hospital in Hunan Province in 2023 was collected.The coefficient of variation(CV)and reduction in variance(RIV)were used to evaluate the classification effect of DRG.Grey relational analysis model was used to analyze the correlation between the various costs and the total inpatient costs,and the structural variation analysis was used to analyze the change trends of each cost in two dimensions:time and inter-group.Results The CV values of total costs and hospitalization days in the DRG group were less than 1,with good intra-group homogeneity;the RIV of hospitalization days in the DRG group was 0.91,with good intra-group heterogeneity;the RIV of total hospitalization costs in the DRG group was 0.38,with poor intra-group heterogeneity;the laboratory examination fees has the greatest correlation with the total hospitalization costs,and the correlation between consumables costs and total hospitalization costs was minimal.Conclusions The consumption of medical resources is not balanced,and the classification effect of dominant diseases treated by TCM is not effective.The proportion of various costs in the total hospitalization costs of patients is unreasonable.The cost change does not fully reflect the labor value of medical personnel,and the cost structure needs to be optimized.Departments have different characteristics,and the fine management needs to be strengthened.