[1]纪 门,孔旭辉,黄秀芹,等.DRG高倍率病例特征分析及管理建议[J].卫生经济研究,2023,40(1):78-82.
　JI Men,KONG Xuhui,HUANG Xiuqin,et al.Cause Analysis and Policy Optimization of DRG High-Rate Cases[J].Journal Press of Health Economics Research,2023,40(1):78-82.
点击复制

DRG高倍率病例特征分析及管理建议
分享到：

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年1期
页码:
78-82
栏目:
医院管理
出版日期:
2023-01-06

文章信息/Info

Title:
Cause Analysis and Policy Optimization of DRG High-Rate Cases
作者:
纪 门1; 孔旭辉1; 黄秀芹1; 张 磊1
1.南京医科大学附属泰州人民医院，江苏 泰州225300
Author(s):
JI Men;  KONG Xuhui;  HUANG Xiuqin;  ZHANG Lei
Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou Jiangsu 225300, China
关键词:
高倍率病例; DRG; 病案首页; 临床路径
Keywords:
high-rate cases;  DRG;  homepage of medical records;  clinical pathway
分类号:
R197.32
文献标志码:
B
摘要:
目的：分析高倍率病例特征，提出相应的管理建议。方法：以某三甲综合医院为样本，描述分析高倍率病例特征，采用χ2检验和t检验，从诊疗难易程度、诊疗行为规范性、新技术或特殊项目使用3个维度，比较分析高倍率病例和正常病例之间的差异。结果：2022年1—3月样本医院高倍率病例903例，ADRG分布内科组占比最高；编码错误导致的高倍率病例占比19.6%；高倍率病例在RW值、并发症/合并症数量、手术分级、危重病例、院内转科、临床路径管理、新技术或特殊项目使用等方面与正常病例之间存在显著性差异。结论：提高病案首页质量，加强高倍率病例临床路径的分析及应对，科学制定高倍率病例认定标准，对使用新技术或特殊项目的高倍率病例给予倾斜支持，加强高倍率病例审核和监管，规避高倍率政策道德风险。
Abstract:
Objective To describe the characteristics of high-rate cases and put forward policy optimization. Methods A tertiary general hospital was chosen to describe the characteristics of high-rate cases. We employed chi-square test and t test to compare the differences between high-rate cases and normal cases from disease difficulty, diagnosis and treatment standardization, and usage of new technology or new projects. Results From January to March, 2022, 903 cases of high-rate cases were included in this study. The proportion of ADRG distribution in internal medicine group ranked first. There were 19.6 % of the cases divided into high rate groups due to coding error. Significant differences were observed between high-rate cases and normal cases in RW value, number of complications, surgical classification, critical cases, hospital transfer, clinical pathway management and usage of new technologies or special projects. Conclusion It is recommended to improve the quality of the homepage of medical records, improve the strategic response and supporting policies for the clinical pathway of high-rate cases, strengthen the review and supervision measures of high-rate cases, and avoid the moral hazard of high-rate cases.

参考文献/References:

[1] 国家医疗保障疾病诊断相关分组（CHS-DRG）分组与付费技术规范[J].中国医疗保险，2021（2）：59.
[2] 金华市医疗保障局.关于印发金华市基本医疗保险住院费用病组（DRGs）点数法付费实施细则的通知[EB/OL].[2019-12-13]. http://ybj.jinhua.gov.cn/art/2019/12/13/art_1229154580_1182240.html.
[3] 南京市医疗保障局.关于印发《南京市基本医疗保险按疾病诊断相关分组（DRG）点数法付费办法》的通知[EB/OL].[2022-01-05].http://ybj.nanjing.gov.cn/gkml/202201/t20220105_3252697.html.
[4] 林敏，夏燕，朱婷，等. DRG付费改革对医院运营效率的影响研究[J].卫生经济研究，2021，38（12）：62-65.
[5] 李梦滢，孙志成，唐尧，等. 基于DRG的公立医院临床路径管理体系建设[J].卫生经济研究，2022，39（2）：67-69，74.
[6] 赵跃，姚东，虞丽娟，等.基于DRG的头颈外科患者费用分析及成本管控策略探讨[J].卫生经济研究，2021，38（12）：69-71.
[7] AiJing Luo,WeiFu Chang,ZiRui Xin,et al.Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm[J].International Journal of Ophthalmology,2018,11(2):308-313.
[8] 梁沛枫，赵媛，杨飞，等.高倍率病例住院费用灰色关联及影响因素回归分析[J].中华医院管理杂志，2020，36（6）：496-499.
[9] Busse R,Geissler A,Aaviksoo A,et al.Diagnosis related groups in Europe:moving towards transparency,efficiency,and quality in hospitals?[J].BMJ,2013,347(7916):19-22.
[10] 泰州市医疗保障局.关于印发泰州市基本医疗保险按疾病诊断相关分组（DRG）点数法付费实施细则（第二版）的通知[EB/OL].[2021-07-29].http://zwgk.taizhou.gov.cn/art/2021/8/5/a rt_63828_3125135.html.
[11] 郭建国，许斯略，余佳莹，等.DRG付费下特殊病例解决路径的眉山实践[J].中国医疗保险，2021（2）：55-59.
[12] Choi J W,Kim S J,Park H K,et al.Effects of a mandatory DRG payment system in South Korea:Analysis of multi-year nationwide hospital claims data[J].BMC Health Services Research, 2019,19(1):776.
[13] Zou K,Li H Y,Zhou D,et al.The effects of diagnosis-related groups payment on hospital healthcare in China:a systematic review[J].BMC Health Servres Research,2020,20(1) :112.

相似文献/References:

[1]丛鹂萱,王海银,金春林.美国创新医疗技术支付经验及启示[J].卫生经济研究,2019,(07):10.
　CONG Li-xuan,WANG Hai-yin,JIN Chun-lin.American Innovative Medical Technology Payment Experience and Enlightenment[J].Journal Press of Health Economics Research,2019,(1):10.
[2]潘春燕.DRG支付方式的实践探讨——以JH市试点情况为例[J].卫生经济研究,2019,(08):38.
　PAN Chun-yan.Discussion on the Practice of DRG Payment Method——Taking the Pilot of JH City as an example[J].Journal Press of Health Economics Research,2019,(1):38.
[3]高 菁,崔 斌,朱兆芳,等.收付费双轨制改革对医院财务管理的影响[J].卫生经济研究,2019,(09):68.
　GAO Jing,CUI Bin,ZHU Zhao-fang,et al.The Impact of the Dual-track Reform of Payment on Hospital Financial Management[J].Journal Press of Health Economics Research,2019,(1):68.
[4]刘荣飞,薛 梅,李紫灵.DRG的国内外研究进展[J].卫生经济研究,2020,(10):42.
　LIU Rong-fei,XUE Mei,LI Zi-ling.Research Progress of DRG at Home and Abroad[J].Journal Press of Health Economics Research,2020,(1):42.
[5]杨 棋,庚 硕,刘 瑾,等.公立医院RBRVS与DRG管理工具结合应用的思考——基于绩效管理视角[J].卫生经济研究,2021,38(3):57.
　YANG Qi,GENG Shuo,LIU Jin,et al.Thoughts on the Combined Application of RBRVS and DRG Management Tools in Public Hospitals——From the Perspective of Performance Management[J].Journal Press of Health Economics Research,2021,38(1):57.
[6]朱碧帆,徐嘉婕,桑培敏,等.DRG支付对医疗服务体系的影响分析——基于OECD实证数据[J].卫生经济研究,2021,38(5):49.
　ZHU Bi-fan,XU Jia-jie,SANG Pei-min,et al.Analysis on the Impact of DRG Implementation on Medical Service System——Based on the Empirical Data of OECD[J].Journal Press of Health Economics Research,2021,38(1):49.
[7]李文瑾,续晓方,田立启,等.基于DRG的乳腺癌手术患者住院费用及影响因素分析[J].卫生经济研究,2021,38(6):76.
　LI Wen-jin,XU Xiao-fang,TIAN Li-qi,et al.Analysis on Hospitalization Expenses and Its Influencing Factors of Breast Cancer Patients Based on DRG[J].Journal Press of Health Economics Research,2021,38(1):76.
[8]赵 迪,王孝勇,郭 磊,等.基于DRG的病组成本核算方法研究[J].卫生经济研究,2021,38(9):65.
　ZHAO Di,WANG Xiao-yong,GUO Lei,et al.Research on DRG-based Cost Accounting Method of Disease Group[J].Journal Press of Health Economics Research,2021,38(1):65.
[9]于 磊,吴佳勉,熊小兰,等.基于DRG的急性心肌梗死患者分组效果评价与费用分析[J].卫生经济研究,2021,38(10):35.
　YU Lei,WU Jia-mian,XIONG Xiao-lan,et al.Evaluation of Grouping Effect and Cost Analysis of Patients with Acute Myocardial Infarction Based on DRG[J].Journal Press of Health Economics Research,2021,38(1):35.
[10]石连忠,梅 彦,余 震,等.杭州市DRG中医支付政策的实践探索[J].卫生经济研究,2021,38(12):16.
　SHI Lian-zhong,MEI Yan,YU Zhen,et al.Practical Exploration of DRG Payment Policy for Traditional Chinese Medicine in Hangzhou[J].Journal Press of Health Economics Research,2021,38(1):16.
[11]杨 松,吴婧文,余丽君,等.DRG高倍率病例现状与政策优化思考[J].卫生经济研究,2022,39(4):24.
　YANG Song,WU Jing-wen,YU Li-jun,et al.Current Situation and Policy Optimization of DRG High-Rate Cases[J].Journal Press of Health Economics Research,2022,39(1):24.
[12]杨若宁,任晓红,廖藏宜,等.DRG付费下特殊病例的影响因素研究[J].卫生经济研究,2024,41(11):44.
　YANG Ruoning,REN Xiaohong,LIAO Zangyi,et al.Study on Influencing Factors of Special Cases under DRG Payment[J].Journal Press of Health Economics Research,2024,41(1):44.

更新日期/Last Update: 2023-01-06