目的本研究旨在探讨按疾病诊断相关分组(diagnosis related groups,DRGs)付费模式下,病案首页质控的重要性及其对医疗质量和费用管理的影响。方法通过对江南大学附属医院质控前(对照组,2022年1—6月)及质控后(观察组,2023年1—6月)期间...目的本研究旨在探讨按疾病诊断相关分组(diagnosis related groups,DRGs)付费模式下,病案首页质控的重要性及其对医疗质量和费用管理的影响。方法通过对江南大学附属医院质控前(对照组,2022年1—6月)及质控后(观察组,2023年1—6月)期间的5000份病案首页数据进行回顾性分析,研究病案首页质控对DRGs分组准确性、医疗费用及医院收入的影响,评估病案首页质控的效果。结果对照组的DRGs分组准确率为(78.6±5.7)%,低于观察组的(90.1±4.3)%,差异有统计学意义(t=113.889,P<0.05)。相较于对照组,观察组的病案首页信息的完整性和准确性提高,编码错误和信息缺失减少,患者人均费用下降,医院收入趋于合理化,医疗资源利用更为高效。结论在DRGs付费模式下,病案首页质控是提升医疗质量和费用管理的关键环节,通过规范化质控流程,不仅提高了病案质量,还优化了医院的经济效益。展开更多
目的:整理我市3家区级三级基层综合医院脑卒中恢复期康复治疗住院患者费用相关数据信息,建立初始患者数据库。通过对住院患者费用的构成和影响因素进行数据分析,为基层医院在DRGs模式下有效控制此类病种患者的医疗费用及制定适宜本地区...目的:整理我市3家区级三级基层综合医院脑卒中恢复期康复治疗住院患者费用相关数据信息,建立初始患者数据库。通过对住院患者费用的构成和影响因素进行数据分析,为基层医院在DRGs模式下有效控制此类病种患者的医疗费用及制定适宜本地区基层医院实施更契合DRGs模式的付费方式提供理论指导。方法:通过病案首页调取428例2022年07月01日至2023年06月30日区间范围内出院主诊断为脑梗死恢复期的患者基本信息(性别、年龄、住院天数、入院时情况等在内的患者基本信息),以及住院费用构成信息(诊查费、治疗费、化验费、药费等在内的患者费用信息),运用Excel及SPSS23.0对患者的住院费用的构成及费用的变动情况进行分析,找出影响住院费用的关键因素,分析DRGs改革后各项费用结构的变动情况及其对总费用变化的影响程度。结果:在四个季度时间区间内脑卒中恢复期患者次均住院费用为14597.26元,次均住院天数为19.34天。灰色关联分析显示,治疗费用、检查费用及药品费用占脑梗死恢复期住院患者费用构成比前三位,其排序:治疗费 > 检查费 > 药品费,关联性小的因素为:诊查费 Objective: To organize data on the cost of rehabilitation treatment for stroke inpatients in three district level and tertiary comprehensive hospitals in our city, and establish an initial patient database, analyze the main influencing factors of hospitalization costs for stroke patients undergoing rehabilitation treatment during the recovery period, and provide reference for grassroots hospitals to control the medical expenses of patients with this disease and implement DRGs payment methods suitable for local grassroots hospitals. Method: 428 patients with primary diagnosis of cerebral infarction and recovery period who were discharged from the hospital between July 1, 2022 and June 30, 2023 were retrieved from the medical record homepage (including basic patient information such as gender, age, length of hospital stay, and admission status), as well as hospitalization expense information (including patient expense information such as diagnosis fees, treatment fees, laboratory fees, medication fees, etc.). Excel and SPSS 23.0 were used to analyze the composition of hospitalization expenses and changes in expenses of patients, identify the key factors affecting hospitalization expenses, and analyze the changes in various expense structures after DRGs reform and their impact on total expense changes. Result: The average hospitalization cost for stroke recovery patients in the four quarter time interval is 14597.26 yuan per visit, and the average hospitalization days per visit is 19.34 days. Grey correlation analysis shows that treatment costs, examination costs, and medication costs account for the top three proportion of hospitalization costs for patients with cerebral infarction in the recovery period. The ranking is treatment costs > examination costs > medication costs. The factor with low correlation is diagnosis costs < surgery costs < bed expenses. The analysis of the degree of change in hospitalization cost structure shows that the first quarter of 2023 had the highest degree of structural change (22.58%), while the time interval with the lowest degree of structural change was the third quarter of 2022 (10.58). The greatest impact of hospitalization costs on stroke recovery rehabilitation patients is treatment costs, followed by examination and medication costs, with contribution rates of 42.21%, 19.80%, and 14.85%, respectively. The total contribution rate of the three costs to hospitalization costs reaches 76.86%, while the average cost of diagnosis, bed, surgery, materials, and other expenses is relatively low, with a structural contribution ratio of less than 3%. The length of hospital stay, treatment method, and admission route are the top three factors that affect the total effect of patient hospitalization costs. Conclusion: The disease burden of inpatients undergoing rehabilitation treatment during the recovery period of stroke is relatively heavy, and the proportion of treatment costs is the highest. This is related to the nature of the patient’s disease. The main purpose of patient hospitalization is rehabilitation treatment, and the proportion of rehabilitation treatment project costs is high, which can continue to be maintained. However, it is necessary to strengthen the monitoring of factors with high correlation such as examination fees and drug costs. In quality control and diagnosis and treatment work, special attention should be paid to exceeding the standard fees, and measures can be actively taken to improve the quality of diagnosis and treatment services while effectively reducing the economic burden of patients with diseases.展开更多
文摘目的本研究旨在探讨按疾病诊断相关分组(diagnosis related groups,DRGs)付费模式下,病案首页质控的重要性及其对医疗质量和费用管理的影响。方法通过对江南大学附属医院质控前(对照组,2022年1—6月)及质控后(观察组,2023年1—6月)期间的5000份病案首页数据进行回顾性分析,研究病案首页质控对DRGs分组准确性、医疗费用及医院收入的影响,评估病案首页质控的效果。结果对照组的DRGs分组准确率为(78.6±5.7)%,低于观察组的(90.1±4.3)%,差异有统计学意义(t=113.889,P<0.05)。相较于对照组,观察组的病案首页信息的完整性和准确性提高,编码错误和信息缺失减少,患者人均费用下降,医院收入趋于合理化,医疗资源利用更为高效。结论在DRGs付费模式下,病案首页质控是提升医疗质量和费用管理的关键环节,通过规范化质控流程,不仅提高了病案质量,还优化了医院的经济效益。
文摘目的:整理我市3家区级三级基层综合医院脑卒中恢复期康复治疗住院患者费用相关数据信息,建立初始患者数据库。通过对住院患者费用的构成和影响因素进行数据分析,为基层医院在DRGs模式下有效控制此类病种患者的医疗费用及制定适宜本地区基层医院实施更契合DRGs模式的付费方式提供理论指导。方法:通过病案首页调取428例2022年07月01日至2023年06月30日区间范围内出院主诊断为脑梗死恢复期的患者基本信息(性别、年龄、住院天数、入院时情况等在内的患者基本信息),以及住院费用构成信息(诊查费、治疗费、化验费、药费等在内的患者费用信息),运用Excel及SPSS23.0对患者的住院费用的构成及费用的变动情况进行分析,找出影响住院费用的关键因素,分析DRGs改革后各项费用结构的变动情况及其对总费用变化的影响程度。结果:在四个季度时间区间内脑卒中恢复期患者次均住院费用为14597.26元,次均住院天数为19.34天。灰色关联分析显示,治疗费用、检查费用及药品费用占脑梗死恢复期住院患者费用构成比前三位,其排序:治疗费 > 检查费 > 药品费,关联性小的因素为:诊查费 Objective: To organize data on the cost of rehabilitation treatment for stroke inpatients in three district level and tertiary comprehensive hospitals in our city, and establish an initial patient database, analyze the main influencing factors of hospitalization costs for stroke patients undergoing rehabilitation treatment during the recovery period, and provide reference for grassroots hospitals to control the medical expenses of patients with this disease and implement DRGs payment methods suitable for local grassroots hospitals. Method: 428 patients with primary diagnosis of cerebral infarction and recovery period who were discharged from the hospital between July 1, 2022 and June 30, 2023 were retrieved from the medical record homepage (including basic patient information such as gender, age, length of hospital stay, and admission status), as well as hospitalization expense information (including patient expense information such as diagnosis fees, treatment fees, laboratory fees, medication fees, etc.). Excel and SPSS 23.0 were used to analyze the composition of hospitalization expenses and changes in expenses of patients, identify the key factors affecting hospitalization expenses, and analyze the changes in various expense structures after DRGs reform and their impact on total expense changes. Result: The average hospitalization cost for stroke recovery patients in the four quarter time interval is 14597.26 yuan per visit, and the average hospitalization days per visit is 19.34 days. Grey correlation analysis shows that treatment costs, examination costs, and medication costs account for the top three proportion of hospitalization costs for patients with cerebral infarction in the recovery period. The ranking is treatment costs > examination costs > medication costs. The factor with low correlation is diagnosis costs < surgery costs < bed expenses. The analysis of the degree of change in hospitalization cost structure shows that the first quarter of 2023 had the highest degree of structural change (22.58%), while the time interval with the lowest degree of structural change was the third quarter of 2022 (10.58). The greatest impact of hospitalization costs on stroke recovery rehabilitation patients is treatment costs, followed by examination and medication costs, with contribution rates of 42.21%, 19.80%, and 14.85%, respectively. The total contribution rate of the three costs to hospitalization costs reaches 76.86%, while the average cost of diagnosis, bed, surgery, materials, and other expenses is relatively low, with a structural contribution ratio of less than 3%. The length of hospital stay, treatment method, and admission route are the top three factors that affect the total effect of patient hospitalization costs. Conclusion: The disease burden of inpatients undergoing rehabilitation treatment during the recovery period of stroke is relatively heavy, and the proportion of treatment costs is the highest. This is related to the nature of the patient’s disease. The main purpose of patient hospitalization is rehabilitation treatment, and the proportion of rehabilitation treatment project costs is high, which can continue to be maintained. However, it is necessary to strengthen the monitoring of factors with high correlation such as examination fees and drug costs. In quality control and diagnosis and treatment work, special attention should be paid to exceeding the standard fees, and measures can be actively taken to improve the quality of diagnosis and treatment services while effectively reducing the economic burden of patients with diseases.
