摘要
目的:分析DRG管理下恶性肿瘤药物治疗基本情况与住院费用影响因素,为医院DRG控费与精细化管理提供参考依据。方法:收集某三甲医院恶性肿瘤药物治疗患者DRG分组与结算信息,运用变异系数与总体方差减小系数评价DRG分组效果,并通过多元逐步回归分析住院费用影响因素。结果:病例主要分布在肿瘤中心和血液病中心,(肿瘤)日间病房收治病例人次占比仅为2.66%,治疗方式以操作类静脉注射化疗药物为主。DRG组内一致性评价指标CV均小于1,组间异质性评价指标RIV>70%。RE13与RE15为亏损病组、RU19为盈余病组,住院费用中位数大小依次为:RE13>RE15>RU19。药品费用是住院费用的首要影响因素,其次为检查费用、住院天数、化验费用、合并症/并发症。结论:本研究DRG分组效果理想,组间权重差异性较好;医院可通过(肿瘤)日间病房有效整合医疗资源,合理降低平均住院日,达到合理控费的目标。医疗保障行政部门通过顶层设计持续降低恶性肿瘤药品费用是合理有效降低住院费用的重要措施,同时也需进一步重点关注体现医务人员的技术劳务价值。
Objective:To analyze the basic situation of drug treatment for malignant tumors and the influence factors of hospitalization expenses under DRG payment,so as to provide a reference for reasonable expense control and delicacy management in a hospital.Methods:The Diagnosis Related Groups and settlement information of inpatients with malignant tumors treated with drugs collected in a Grade III Level A hospital,the DRG grouping effect was evaluated by the coefficient of Variation and reduction coefficient of total Variance.Analyze basic information and hospitalization expenses of inpatients.The influencing factors of hospital expenses were analyzed by multiple stepwise regression.Results:The cases were mainly distributed in the cancer treatment centers and hematological disease treatment centers.The proportion of inpatients admitted to the(cancer)day-care unit was only 2.66%.Chemotherapeutics by intravenous injection was the main treatment method.The coefficient of Variation value of the DRG groups was less than 1.The reduction of variation value of the DRG group was more than 70%.RE13 and RE15 were all the deficit groups,and RU19 was the surplus group.The median numerical value of hospitalization expenses in each group:RE13>RE15>RU19.Drug fee was the primary influence factor on hospitalization expenses,examination fee,length of hospital stay,laboratory test fee,and complications/complications were also the influence factors.Conclusion:The effect of grouping DRG cases of malignant tumors was significant.The objective of controlling hospitalization expenses will be achieved by taking full advantage of the(cancer)day-care unit which can integrate medical resources effectively to reduce the average length of hospital stay.Top-level design by the Medical security administrative department which can reduce the unit price of drugs for malignant tumors was an important measure to control hospitalization expenses effectively.It’s necessary to pay attention to the cost that reflects the value of medical staff’s technical
作者
葛龙
张南
王月
GE Long;ZHANG Nan;WANG Yue(State Key Laboratory of Pathogenesis,Prevention and Treatment of High Incidence Diseases in Central Asia,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region,830001,PRC)
出处
《中国医院》
北大核心
2023年第1期49-52,共4页
Chinese Hospitals
基金
新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-XCZX202237)
新疆医科大学省部共建中亚高发病成因与防治国家重点实验室开放课题(SKLHIDCA-2021-54)。
关键词
DRG
恶性肿瘤
住院费用
DRG
malignant tumor
hospitalization expenses
