摘要
目的基于病案首页评价新型冠状病毒肺炎(新冠肺炎)疫情对综合医院疾病诊断相关分组(diagnosis related group,DRG)的影响。方法选择南京市第一医院2019年2月—3月(疫情前)、2020年2月—3月(疫情中)出院病案首页数据,计算总权重、DRG组数、病例组合指数指数、时间消费指数及费用消耗指数等5项指标,采用秩和比(rank-sum ratio,RSR)法比较科室DRG指标秩次,通过频率分布、计算直线回归方程对科室进行分档排序,同时观察新冠肺炎疫情对手术科室和非手术科室DRG指标的影响。结果2019年2月—3月共纳入28个科室,2020年2月—3月共纳入25个科室。新冠肺炎疫情发生后,科室总DRG指标秩次(RSR)由12.982降至11.710。分档排序下降的科室有眼科、烧伤科、骨科、耳鼻咽喉科、口腔科和疼痛科;分档排序上升的科室有妇科、肿瘤科、免疫科和神经内科。新冠肺炎疫情暴发后,手术科室与非手术科室DRG相关指标在总权重、DRG组数方面均下降明显(P<0.05)。结论新冠肺炎疫情影响医院总体收治难度和质量,手术科室受累明显,多个科室RSR降低档次等级。面对疫情,医院应该通过提升"技术源"、保证"病源池"、优化"流程链"、强化"新媒体"等手段来抵消或弱化疫情对医院疾病收治带来的不确定性,保证医院的高质量收治。
Objective To evaluate the coronavirus disease 2019(COVID-19)impact on diagnosis related groups(DRGs)in a general hospital based on the front page of the medical record.Methods The first page data of discharge medical records of Nanjing First Hospital from February to March 2019(before the epidemic)and from February to March 2020(during the epidemic)were selected.Five indexes including total weight,number of DRGs,case mixed index index,time consumption index and cost consumption index were calculated.The rank of DRGs indexes of departments was compared by rank-sum ratio(RSR)method.The departments were sorted by frequency distribution and linear regression equation.Meanwhile,the COVID-19 impact on DRGs index of surgical departments and non operative departments was observed.Results Twenty-eight departments were included from February to March 2019,and 25 departments were included from February to March 2020.After the outbreak of COVID-19,the total DRGs index rank(RSR)decreased from 12.982 to 11.710.Ophthalmology,burn and plastic surgery,orthopedics,otorhinolaryngology,stomatology and pain department were the departments with lower ranking;the departments of gynecology,oncology,immunology and neurology were ranked higher.After the outbreak of COVID-19,the DRGs related indexes of surgical departments and non-surgical departments decreased significantly in terms of total weight and the number of DRGs(P<0.05).Conclusions COVID-19 affects the overall quality of hospital difficulty,and the surgical departments are significantly involved.The RSR level of several departments is reduced.In the face of the epidemic situation,hospitals should offset or weaken the uncertainty brought by the epidemic situation to the hospital disease treatment and ensure the high-quality hospital treatment by improving the“technical source”,ensuring the“disease source pool”,optimizing the“process chain”and strengthening the“new media”.
作者
龚伟伟
王书奎
业海燕
GONG Weiwei;WANG Shukui;YE Haiyan(Medical Department,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing,Jiangsu 210006,P.R.China)
出处
《华西医学》
CAS
2022年第2期176-181,共6页
West China Medical Journal
基金
2021年度医院管理创新研究立项课题重点课题(JSYGY-2-2021-62)
南京医科大学2021年度校级教育研究课题(2021LX039)。
