摘要
目的探索脑缺血性疾病患者个人负担率的影响因素,比较不同严重程度脑缺血患者的个人负担率影响因素的差异,为制定自负率相关考核标准提供一定参考依据,并就控制个人负担率增长提供建议。方法以天津市某三甲专科医院为研究现场,选取2022年1月—12月共8164例脑缺血出院患者,采用广义线性模型分析不同DRG分组个人负担率的影响因素。结果不同DRG组之间的费用结构存在统计学差异。年龄、住院时间、住院总费用、入院途径、住院次数、参保人员类型对个人负担率具有显著影响,个人负担率与年龄、住院时间负相关,与住院总费用为正相关,急诊入院、首次住院、城镇职工参保患者的个人负担率更低。结论医院绩效考核对患者个人负担率进行评价时,应针对不同险种的患者制定差异化指标,将平均住院日时间、平均住院费用等项目纳入参考因素,并依照内外科收治患者以及临床路径的特点,制定更加公平的院内考核方案。医药机构应通过减少医保目录内项目按自费申报、提高病例入组率以及推动分级诊疗的方式,降低患者个人负担率。
Objective This study aimed to investigate the factors influencing the personal burden rate incerebral ischemic patients,compare the difference in the burden rate among the patients with varying degrees of cerebral ischemia,provide a reference for establishing a personal burden rate evaluation,and propose suggestions for control its increase.Methods The medical insurance data were collected from 8164 discharged patients in a tertiary hospital in Tianjin between January and December 2022.With the data,the Generalized Linear Model was utilized to analyze the factors affecting the personal burden rate across different Diagnosis Related Groups(DRGs).Results Statistically significant differences were observed in the cost structure among different DRGs.Age,length of hospital stays,total hospitalization cost,hospital admission mode,number of hospitalizations,and type of medical insurance significantly impacted the personal burden rate.The personal burden rate was inversely correlated with age and length of hospital stays,but directly correlated with the total hospitalization cost.The patients admitted from emergency,first-time hospitalization,and those covered by the basic medical insurance program for urban employees had a lower personal burden rate.Conclusion Hospitals should establish diverse personal burden rate performance evaluation standards for patients with different types of medical insurance,incorporating factors such as average length of hospital stays and average hospitalization cost.A more equitable hospital internal assessment plan should be developed by considering patients admitted to different departments and aligning with the characteristics of clinical pathways.Medical institutions should minimize self-funded projects under declared medical insurance,increase the enrollment of cases in DRGs,and promote tiered diagnosis and treatment to reduce the personal burden rate for patients.
作者
余沛林
陈博年
伊越
马帅
范予晨
YU Peilin;CHEN Bonian;YI Yue;MA Shuai;FAN Yuchen(Tianjin Huanhu Hospital,Tianjin 300350,China;Tianjin Key Laboratory of Retinal Functions and Diseases,Tianjin Branch of National Clinical Research Center for Ocular Disease,Eye Institute and School of Optometry,Tianjin Medical University Eye Hospital,Tianjin 300384,China;Tianjin Center for Disease Control and Prevention,Tianjin 300111,China;School of Marxism Studies,Tianjin Medical University,Tianjin 300070,China)
出处
《现代医院》
2024年第2期258-262,共5页
Modern Hospitals
关键词
DRG
个人负担率
脑缺血
医保
绩效考核
DRGs
Personal burden rate
Cerebral ischemia
Medical insurance
Performance evaluation
