DRGs付费对高龄股骨转子间骨折患者行人工股骨置换术中医疗行为的影响研究
Research of the Effect of DRGs on the Doctor's Behavior of Elderly Patients with Intertrochanteric Fracture After Artificial Femoral Head Replacement
王明友 1兰玉平 1何忠成 1王洪平 1陶崎峰 1陈春雨 1吴飞鹏1
作者信息
- 1. 攀枝花市中心医院骨科,四川 攀枝花 617000
- 折叠
摘要
目的 评价DRGs付费对高龄股骨转子间骨折患者行人工股骨头置换术中医疗行为的影响.方法 回顾性分析2016 年1 月至2021 年10 月在我院收治的高龄股骨转子间骨折行人工股骨头置换术患者,根据DRGs应用前后将其分为对照组与观察组,分析住院费用、住院时间及反映医生医疗行为相关指标.结果 对照组纳入 82 例,观察组纳入98 例,两组患者年龄、性别、受伤原因、骨折分型及手术时间等基本资料差异无统计学意义(P>0.05).DRGs背景下,高龄股骨转子间骨折患者术前等待时间缩短至(4.23±2.03)d,术中出血量、输液量、输血率均较前下降(P<0.05);术后尿管及引流管留置率降低,抗生素使用时间缩短,实现早期下床活动,平均住院日缩短至(15.33±3.93)d,差异均有统计学意义(P<0.05).住院费用(除去材料费)下降为(25184.71±4223.37)元,降幅为 7.86%(P<0.05),其中手术费、麻醉费、治疗费、护理费较前增加,检查费、输血费、其他费用、药品费、床位费、检验费较前降低(P<0.05).DRGs实施后,在不增加术后并发症发生率和90d再入院率的基础上,改善术后患髋疼痛及髋关节功能评分,提高患者满意度,差异均具有统计学意义(P<0.05).结论 DRGs付费制度在高龄股骨转子间骨折行人工股骨头置换术患者中的应用可促进医护人员主动学习新理念、新技术,通过强化术前宣教,优化饮食管理、血液管理、疼痛管理、管道管理、体温管理,早期功能锻炼等快速康复理念的应用,在缩短住院时间、降低住院费用的基础上规范了医疗服务提供者的诊疗及收费行为,保障医疗质量的同时提高医疗服务效率,增加患者满意度.
Abstract
Objective To study effects of DRGs on doctor's behavior of elderly patients with intertrochanteric fracture after femoral head replacement.Methods From January 2016 to October 2021,elderly patients with intertrochanteric fracture of femur who underwent artificial femoral head replacemen were divided into control group and observation group according to the application of DRGs before and after,and hospital expenses,hospital stay and related indicators reflecting the medical behavior of doctors were analyzed.Results There were 82 patients in control group and 98 patients in observation group.There was no statistical difference between two groups in basic data such as age,sex,cause of injury,fracture classification and operation time(P>0.05).Under the background of DRGs,preoperative waiting time of elderly patients with intertrochanteric fracture of femur was shortened to(4.23±2.03)d,and intraoperative blood loss,transfusion volume and blood transfusion rate were all lower than be-fore(P<0.05).The retention rate of urinary catheter and drainage tube decreased after operation,the use time of antibiotics was shortened,and the average hospital stay was shortened to(15.33±3.93)d,the differences are statistically significant(P<0.05).The cost of hospitalization(excluding material costs)decreased to(25184.71±4223.37)yuan,with a decrease of 7.86%(P<0.05).The cost of surgery,anesthesia,treatment and nursing increased,and the cost of examinotion,blood transf-wsion,other expenses,medicines,beds and tests decreased(P<0.05).After implementation of DRGs,on the basis of not in-creasing the incidence of postoperative complications and the 90-day readmission rate,scores of postoperative hip pain and hip joint function were improved,and patients'satisfaction was improved with statistically significant difference(P<0.05).Conclu-sion The application of DRGs in elderly patients with intertrochanteric fracture undergoing artificial femoral head replacement could promote medical staff to actively learn new concepts and new technologies,and optimize the application of fast rehabilitation concepts such as strengthening preoperative education,diet management,blood management,pain management,pipeline manage-ment,body temperature management,functional exerciseearly,etc.On the basis of shorting hospital stay and reducing hospitaliza-tion expenses,it not only standardizes the behavior ofdiagnosis,treatment and charging of medical service providers,ensures med-ical quality,but also improves medical service efficiency and increases patient satisfaction.
关键词
快速康复/疾病诊断相关分组/高龄/股骨转子间骨折/置换/医疗行为/应用与研究Key words
enhanced recovery after surgery/diagnosis related groups/elderly/intertrochanteric fracture of femur/arthro-plasty/doctor's behavior/application and research引用本文复制引用
基金项目
川北医学院四川省基层卫生事业发展研究中心项目(2021)(SWFZ21-C-111)
出版年
2024
国家科技期刊平台
NSTL
万方数据