| 李佳艺,顾民,樊宏伟.南京市DRG改革前后脑血管病介入治疗住院费用分析[J].中国医药导报,2024,21(2):70-75 |
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| 南京市DRG改革前后脑血管病介入治疗住院费用分析 |
| Analysis of hospital expenses for interventional treatment of cerebrovascular diseases before and after DRG reform in Nanjing |
| 收稿日期：2023-04-25 |
| DOI：10.20047/j.issn1673-7210.2024.02.14 |
| 关键词: 脑血管介入治疗 疾病诊断分组 DRG支付改革 南京 |
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| 基金项目:江苏省研究型医院学会科研基金项目（JY202001） |
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| 摘要:目的 以脑血管介入治疗（BE29）病组为例探索南京定点医疗机构2022年起实施的疾病诊断相关分组（DRG）支付改革效果，为该病种的细化规则提供参考。 方法 回顾性收集南京某两家公立医院神经外科2021年（改革前，349例）、2022年（改革后，427例）BE29病组的出院患者，分析改革前后该病组患者人均费用及其结构变化，评估DRG控费效果。根据2022年住院总费用倍率分析DRG改革后盈亏情况。将BE29病组按诊断类型（脑梗死、不伴有梗死的颅内血管阻塞和狭窄、颅内动脉瘤）进一步分组，分析各亚组病例费用的差异及亚组划分的可行性，并对费用最高的亚组进行费用的影响因素探讨。 结果 改革后，BE29病组人均药品费用低于改革前，人均耗材和人均检查费用高于改革前，差异有统计学意义（P＜0.05）。住院天数与倍率呈正相关，各项费用随着倍率的升高而增加，差异有统计学意义（P＜0.05）。改革前后，动脉瘤亚组费用均高于两个脑缺血亚组，差异有统计学意义（P＜0.05）；在脑缺血患者中，改革后脑梗死亚组费用高于未伴有梗死的颅内血管阻塞或狭窄亚组，差异有统计学意义（P＜0.05）；改革前后，BE29总病组医疗费用高于亚组脑梗死（BE29.1）及颅内血管阻塞和狭窄介入治疗（BE29.2）的费用，低于颅内动脉瘤介入治疗（BE29.3）的费用，差异有统计学意义（P＜0.05）。不同年龄、动脉瘤的破裂、多发性、支架辅助栓塞及住院时间与颅内动脉瘤介入治疗住院费用比较，差异有统计学意义（P＜0.05）。在多因素分析中，动脉瘤的多发性和住院天数是费用的独立影响因素（P＜0.05）。 结论 BE29病组应综合考虑不同诊断类型费用及其影响因素的差异性，细化付费规则的制订，更体现医疗劳务价值。 |
| Abstract:Objective To take the cerebrovascular interventional therapy (BE29) group as an example, to explore the effect of diagnosis related groups (DRG) payment reform implemented in Nanjing designated medical institutions since 2022, and to provide reference for the detailed rules of this disease. Methods The patients discharged from the Department of Neurosurgery in two public hospitals in Nanjing in 2021 (349 cases before the reform) and 2022 (427 cases after the reform) were retrospectively collected, and the per capita cost and structural changes of the patients in this group were analyzed before and after the reform, and the effect of DRG on cost control was evaluated. The profit and loss situation after the implementation of DRG reform was analyzed according to the ratio of total hospitalization cost in 2022. The BE29 disease group was further divided according to the diagnosis type (cerebral infarction, intracranial vascular obstruction and stenosis without infarction, intracranial aneurysm), and the differences of case costs in each subgroup and the feasibility of subgroup division were analyzed, and the influencing factors of cost were discussed for the subgroup with the highest cost. Results After the reform, the drug cost of Enjun in BE29 patients was lower than before the reform, and the per capita consumables and examination cost were higher than before the reform, with statistical significance (P＜0.05). The length of hospitalization was positively correlated with the rate, and the costs increased with the rate increasing, the difference was statistically significant (P＜0.05). Before and after reform, the cost of aneurysm subgroup was higher than that of cerebral ischemia subgroup, the difference was statistically significant (P＜0.05). In cerebral ischemia patients, the cost of cerebral infarction subgroup after reform was higher than that of intracranial vascular obstruction or stenosis subgroup without infarction, the difference was statistically significant (P＜0.05). Before and after the reform, the medical expenses of BE29 total disease group were higher than those of subgroup cerebral infarction (BE29.1) and intracranial vascular obstruction and stenosis (BE29.2), and lower than those of intracranial aneurysm (BE29.3), with statistical significance (P＜0.05). There were significant differences in age, aneurysm rupture, multiple aneurysms, stent-assisted embolization and hospital stay compared with intracranial aneurysm interventional treatment (P＜0.05). In multivariate analysis, the multiple aneurysms and length of stay were independent factors of cost (P＜0.05). Conclusion BE29 patients should consider the differences of different diagnosis types and their influencing factors, and refine the payment rules to reflect the value of medical service. |
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