Analysis of hospital expenses for interventional treatment of cerebrovas-cular diseases before and after DRG reform in Nanjing
Objective To take the cerebrovascular interventional therapy(BE29)group as an example,to explore the effect of diagnosis related groups(DRG)payment reform implemented in Nanjing designated medical institutions since 2022,and to provide reference for the detailed rules of this disease.Methods The patients discharged from the Department of Neurosurgery in two public hospitals in Nanjing in 2021(349 cases before the reform)and 2022(427 cases after the reform)were retrospectively collected,and the per capita cost and structural changes of the patients in this group were analyzed before and after the reform,and the effect of DRG on cost control was evaluated.The profit and loss situation after the implementation of DRG reform was analyzed according to the ratio of total hospitalization cost in 2022.The BE29 disease group was further divided according to the diagnosis type(cerebral infarction,intracranial vascular obstruction and stenosis without infarction,intracranial aneurysm),and the differences of case costs in each subgroup and the feasibility of subgroup division were analyzed,and the influencing factors of cost were discussed for the subgroup with the highest cost.Results After the reform,the drug cost of Enjun in BE29 patients was lower than before the reform,and the per capita consumables and examination cost were higher than before the reform,with statistical significance(P＜0.05).The length of hospitalization was positively correlated with the rate,and the costs increased with the rate increasing,the difference was statistically significant(P＜0.05).Before and after reform,the cost of aneurysm subgroup was higher than that of cerebral ischemia subgroup,the difference was statistically significant(P＜0.05).In cerebral ischemia patients,the cost of cerebral infarction subgroup after reform was higher than that of intracranial vascular obstruction or stenosis subgroup without infarction,the difference was statistically significant(P＜0.05).Before and after the reform,the medical expenses of BE29 total disease group were higher than those of subgroup cerebral infarction(BE29.1)and intracranial vascular obstruction and stenosis(BE29.2),and lower than those of intracranial aneurysm(BE29.3),with statistical significance(P＜0.05).There were significant differences in age,aneurysm rupture,multiple aneurysms,stent-assisted embolization and hospital stay compared with intracranial aneurysm interventional treatment(P＜0.05).In multivariate analysis,the multiple aneurysms and length of stay were independent factors of cost(P＜0.05).Conclusion BE29 patients should consider the differences of different diagnosis types and their influencing factors,and refine the payment rules to reflect the value of medical service.
Cerebrovascular interventionsDiagnosis related groupsPayment reformNanjing
NETL
NSTL
万方数据
