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DRGs付费模式下脑缺血患者个人负担率影响因素研究

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目的 探索脑缺血性疾病患者个人负担率的影响因素,比较不同严重程度脑缺血患者的个人负担率影响因素的差异,为制定自负率相关考核标准提供一定参考依据,并就控制个人负担率增长提供建议。方法 以天津市某三甲专科医院为研究现场,选取2022 年 1 月—12 月共 8 164 例脑缺血出院患者,采用广义线性模型分析不同DRG分组个人负担率的影响因素。结果 不同DRG组之间的费用结构存在统计学差异。年龄、住院时间、住院总费用、入院途径、住院次数、参保人员类型对个人负担率具有显著影响,个人负担率与年龄、住院时间负相关,与住院总费用为正相关,急诊入院、首次住院、城镇职工参保患者的个人负担率更低。结论 医院绩效考核对患者个人负担率进行评价时,应针对不同险种的患者制定差异化指标,将平均住院日时间、平均住院费用等项目纳入参考因素,并依照内外科收治患者以及临床路径的特点,制定更加公平的院内考核方案。医药机构应通过减少医保目录内项目按自费申报、提高病例入组率以及推动分级诊疗的方式,降低患者个人负担率。
Influential factors of personal burden rate in cerebral ischemic patients based on DRGs payment model
Objective This study aimed to investigate the factors influencing the personal burden rate incerebral ische-mic patients,compare the difference in the burden rate among the patients with varying degrees of cerebral ischemia,provide a reference for establishing a personal burden rate evaluation,and propose suggestions for control its increase.Methods The medi-cal insurance data were collected from 8164 discharged patients in a tertiary hospital in Tianjin between January and December 2022.With the data,the Generalized Linear Model was utilized to analyze the factors affecting the personal burden rate across different Diagnosis Related Groups(DRGs).Results Statistically significant differences were observed in the cost structure a-mong different DRGs.Age,length of hospital stays,total hospitalization cost,hospital admission mode,number of hospitaliza-tions,and type of medical insurance significantly impacted the personal burden rate.The personal burden rate was inversely cor-related with age and length of hospital stays,but directly correlated with the total hospitalization cost.The patients admitted from emergency,first-time hospitalization,and those covered by the basic medical insurance program for urban employees had a lower personal burden rate.Conclusion Hospitals should establish diverse personal burden rate performance evaluation standards for patients with different types of medical insurance,incorporating factors such as average length of hospital stays and average hospi-talization cost.A more equitable hospital internal assessment plan should be developed by considering patients admitted to differ-ent departments and aligning with the characteristics of clinical pathways.Medical institutions should minimize self-funded pro-jects under declared medical insurance,increase the enrollment of cases in DRGs,and promote tiered diagnosis and treatment to reduce the personal burden rate for patients.

DRGsPersonal burden rateCerebral ischemiaMedical insurancePerformance evaluation

余沛林、陈博年、伊越、马帅、范予晨

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天津市环湖医院 天津 300350

天津医科大学眼科医院//眼视光学院 眼科研究所//国家眼耳鼻喉疾病临床医学研究中心天津市分中心//天津市视网膜功能与疾病重点实验室 天津 300384

天津市疾病预防控制中心 天津 300011

天津医科大学马克思主义学院 天津 300070

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DRG 个人负担率 脑缺血 医保 绩效考核

2024

现代医院
广东省医院协会

现代医院

影响因子:1.332
ISSN:1671-332X
年,卷(期):2024.24(2)
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