摘要
目的:探讨国家医疗保障疾病诊断相关分组下感染高风险区域多重耐药菌(Multi-drug Resistance Organism,MDRO)感染管理控费模式的效果。方法:回顾性分析玉林市第一人民医院管理前2022年4月至2022年12月感染高风险区域重症医学科(Intensive Care Unit,ICU)、烧伤整形外科运行数据,选取发生MDRO感染的病例住院总费用占相应病组总费用较高比例且次均结算差额大的病组,即ICU中AH11病组(205例)、SB11病组(56例)和烧伤整形外科JD13病组(154例)、JJ13病组(91例)。经MDRO感染综合管理后,对比2023年4月至2023年12月ICU的AH11病组(262例)、SB11病组(55例)和烧伤整形外科JD13病组(152例)、JJ13病组(52例)中MDRO感染病例住院总费用占比、次均费用、次均结算差额、平均住院日、MDRO医院感染发生率以及出院患者治疗性使用抗菌药物病原学送检率、抗菌药物使用强度。结果:ICU、烧伤整形外科病组工作人员管理前、管理后的工作年限、学历、岗位比较,差异无统计学意义(P>0.05)。科室主任/护士长专项绩效考评效果较好,扣罚绩效评分呈下降趋势。ICU、烧伤整形外科各病组管理前、管理后性别、年龄比较,差异无统计学意义(P>0.05)。与管理前比较,ICU中AH11病组管理后MDRO感染病例住院总费用占比、次均费用、次均结算差额、平均住院日均下降(P<0.05);与管理前比较,ICU中SB11病组管理后MDRO感染病例住院总费用占比、平均住院日均下降(P<0.05),ICU中SB11病组次均费用、次均结算差额管理前、管理后比较,差异无统计学意义(P>0.05)。与管理前比较,烧伤整形外科JD13病组和JJ13病组管理后MDRO感染病例住院总费用占比、次均费用、次均结算差额、平均住院日均下降(P<0.05),其中JD13病组次均结算差额扭亏为盈,JJ13病组次均结算差额亏损明显减少。与管理前比较,ICU中AH11病组管理后MDRO医院感染发生率下降(P<0.05)。ICU中SB11病组MDRO医院感染发生率管理前、管理后比较,差异无统计学意义(P>0.05)。与管理前比较,烧伤整形外科JD13病组管理后MDRO医院感染发生率下降(P<0.05)。烧伤整形外科JJ13病组MDRO医院感染发生率管理前、管理后比较,差异无统计学意义(P>0.05)。ICU、烧伤整形外科出院患者治疗性使用抗菌药物病原学送检率、抗菌药物使用强度管理前、管理后比较,差异无统计学意义(P>0.05)。管理后ICU、烧伤整形外科MDRO检出率下降。MDRO医院感染防控措施执行率升高。结论:国家医疗保障疾病诊断相关分组下感染高风险区域的MDRO感染管理控费模式可有效减少病组亏损和MDRO医院感染发生率,提升医疗机构精细化管理质量。
Objective:To explor the effectiveness of the management and control costs of multidrug-resistant organisms(MDRO)infections in high risk areas under the China healthcare security diagnosis related groups.Methods:Retrospective analysis of operational data of intensive care unit(ICU)and burn plastic surgery in high risk infection areas of Yulin First People's Hospital from April 2022 to December 2022 before management.Selecting cases with MDRO infection,the total hospitalization cost accounts for a higher proportion of the total cost of the corresponding disease group and the average settlement difference per case was in the major disease group.AH11 disease group(205 cases),SB11 disease group(56 cases)in ICU and JD13 disease group(154 case),JJ13 disease group(91 cases)in burn plastic surgery.After comprehensive management of MDRO infection,compared the proportion of total hospitalization cost,average cost per visit,average settlement difference per visit,average length of hospita stay for MDRO infection cases,the incidence of MDRO hospital infections therapeutic use of antibiotics pathogen testing rate and intensity of antibiotic use among hospitalized patients inAH11 disease group(262 cases),SB11 disease group(55 cases)in ICU and JD13 disease group(152 cases),JJ13 disease group(52 cases)in burn plastic surgery from April 2023 to December 2023.Results:Comparison of work experience,educational background and post of ICU and burn plastic surgery disease group staff before and after management,the difference was not statistically significant(P>0.05).The special performance evaluation of department heads/nursing supervisors has shown good results,but the deduction and punishment performance scores have shown a downward trend.Comparison of gender and age among different disease groups in ICU and burn plastic surgery before and after management,the difference was not statistically significant(P>0.05).Compared with before management,the proportion of total hospitalization cost,average cost per visit,average settlement difference per visit and average length of hospita stay for MDRO infection cases in AH11 disease group in ICU were decreased after management(P<0.05).Compared with before management,the proportion of total hospitalization cost and average length of hospita stay for MDRO infection cases in SB1l disease group in ICU were decreased after management(P<0.05),Comparison of average cost per visit and average settlement difference per visit in SB11 disease group in ICU before and after management,the difference was not statistically significant(P>0.05).Compared with before management,the proportion of total hospitalization cost,average cost per visit,average settlement difference per visit and average length of hospita stay for MDRO infection cases in JD13 disease group and J13 disease group in burn plastic surgery were decreased after management(P<0.05),Among them,the JD13 disease group average settlement difference per visit has turned losses into profits,while the JJ13 disease group average settlement difference loss has significantly decreased.Compared with before management,the incidence of MDRO hospital infections in the AH11 disease group in ICU decreased after management(P<0.05).Comparison of the incidence of MDRO hospital infections in SBl 1 disease group in ICU before and after management,the difference was not statistically significant(P>0.05).Compared with before management,the incidence of MDRO hospital infections in the JD13 disease group in burn plastic surgery decreased after management(P<0.05).Comparison of the incidence of MDRO hospital infections in JJ13 disease group in burn plastic surgery before and after management,the difference was not statistically significant(P>0.05).Comparison of antibiotics pathogen testing rate and intensity of antibiotic use in ICU and burn plastic surgery discharged patients before and after management,the difference was not statistically significant(P>0.05).The detection rate of MDRO in ICU and burn plastic surgery decreased after management.The implementation rate of prevention and control measures for MDRO hospital infections has increased.Conclusions:The management and control costs model of MDRO infections in high risk areas under the China healthcare security diagnosis related groups can effectively reduce losses and the incidence of MDRO hospital infections in disease group,enhance the quality of refined management in medical institutions.
作者
凌圣惠
辛燕
吕斌
梁业梅
张广兰
LING Sheng-hui;XIN Yan;LU Bin;LIANG Ye-mei;ZHANG Guang-lan(Department of Infection Management,Yulin First People's Hospital,Yulin,Guangxi,537000,China;Medical Insurance Management Office,Yulin First People's Hospital,Yulin,Guangxi,537000,China)
出处
《现代生物医学进展》
2026年第3期455-465,共11页
Progress in Modern Biomedicine
基金
2024年度广西壮族自治区卫生健康委西医类自筹经费科研项目(Z-K20241730)。
关键词
国家医疗保障疾病诊断相关分组
高风险区域
多重耐药菌
感染管理
医疗控费
China healthcare security diagnosis related groups
High risk areas
Multidrug-resistant organism
Infection management
Medical cost control
