基于DRG的重症医学科病例费用结构比较分析及分组效能研究

Comparative analysis of case cost structure and grouping efficiency in intensive care unit based on DRG

目的探讨重症医学科(ICU)病例的住院费用构成及疾病诊断相关分组(DRG)分组效能。方法回顾性分析2019年1月1日至2022年12月31日在西安交通大学第一附属医院治疗的11378例ICU患者的入组情况,筛选出例数排名前10位的病组,分析该10组的费用结构;并采用变异系数评价ICU的前10位病组及全院相同病组。结果外科ICU的三个病组,主要费用构成为药费及耗材费,平均占总费用的69.82%。其余病组费用构成主要集中在药费及诊断费。前10位病组的分组效果较好(变异系数<1),但在相同DRG中,ICU出院患者组住院费用的变异系数普遍低于全院出院患者组,因此,对于相同DRG组,ICU出院患者单独评价时组内住院费用的同质性更高。结论建议进一步细化ICU相关分组,或建立切实可行的ICU患者补偿付费机制。在满足医保控费需要的同时,达到合理付费的目的。

Objective To explore the composition of hospitalization costs and the grouping efficiency of diagnosis related group(DRG)in intensive care unit(ICU)cases.Methods The enrollment of 11378 ICU patients treated in the First Affiliated Hospital of Xi’an Jiaotong University from January 1,2019 to December 31,2022 was analyzed retrospectively,and the top ten disease groups were screened out,and the cost structure of the ten groups was analyzed.The coefficient of variation was used to evaluate the top ten disease groups in ICU and the same disease group in the whole hospital.Results The main cost components of the three disease groups in the surgical ICU were medication and consumables,accounting for an average of 69.82%of the total cost.The cost composition of other disease groups mainly focused on medication and diagnostic costs.The grouping effect of the top ten disease groups was good(coefficient of variation<1),but in the same disease DRG,the coefficient of variation of hospitalization costs in the ICU discharged patient group was generally lower than that in the whole hospital discharged patient group.Therefore,for the same DRG group,the homogeneity of hospitalization costs in the ICU discharged patient group was higher when evaluated separately.Conclusion It is suggested to further refine the related grouping of ICU or establish a feasible compensation payment mechanism for ICU patients.While meeting the needs of medical insurance cost control,the purpose of reasonable payment is achieved.