摘要
目的探讨疾病诊断相关分组(DRG)支付背景下,利用焦点管理循环(FOCUS-PDCA)质量管理工具优化关节外科肩袖损伤患者的临床路径。方法分别选取2024年1—6月与2024年7—12月在某三甲医院关节外科住院肩袖损伤患者作为对照组和观察组,每组各171人,其中观察组实施FOCUS-PDCA,比较2组肩袖损伤患者费用数据,包括总费用、DRG费用、医保实际费用、DRG支付率、次均费用、次均医疗费、次均医技费、次均药品费、药占比、次均耗材费、耗占比。结果实施FOCUS-PDCA后,观察组肩袖损伤患者费用降幅较为明显的为次均耗材费、医保实际费用、总费用、次均费用(P<0.01),观察组DRG费用、次均医技费、次均医疗费3项指标较对照组升高(P<0.01),DRG支付率由65.74%提升至94.07%。结论对于关节外科肩袖损伤患者,FOCUS-PDCA应用于DRG和临床路径管理中,有利于改善DRG指标数据,降低患者住院费用,提升管理效率。
Objective To optimize the clinical pathway of patients with rotator cuff injury using the find,organize,clarify,understand,select-plan,do,check,action(FOCUS-PDCA)quality management tool in the context of diagnosis-related group(DRG)payment.Methods The patients with rotator cuff injury who were hospitalized in the Department of Joint Surgery of a tertiary hospital in 2024 were selected as the research objects.They were assigned to control group(admitted to the hospital from January to June)or observation group(from July to December).Cost data,such as total cost,DRG cost,actual cost of medical insurance,DRG payment rate,average cost per visit,average medical expenses per visit,average medical technology cost per visit,average drug cost per visit,proportion of drugs,average cost of consumables per visit,and proportion of consumption were compared before and after FOCUS-PDCA implementation.Results After the implementation of FOCUS-PDCA,average cost of consumables,actual cost of medical insurance,total cost,and average cost were significantly decreased(P<0.01),DRG cost,average medical technology fee per visit,and average medical expenses per visit in the observation group were higher than those in the control group(P<0.01),the DRG payment rate increased from 65.74%to 94.07%.Conclusion For patients with rotator cuff injury,FOCUS-PDCA used in the management of DRG and clinical pathway is beneficial to improve DRG data,reduce hospitalization costs,and promote management efficiency.
作者
王海林
郭玉峰
翟继标
陈军
贺海芳
马珺玲
乔安花
Wang Hailin;Guo Yufeng;Zhai Jibiao;Chen Jun;He Haifang;Ma Junling;Qiao Anhua(The Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)
出处
《海军医学杂志》
2026年第1期52-56,共5页
Journal of Navy Medicine
基金
海军军医大学第二附属医院管理政策研究课题(2024YLZL01)。
