DRGs支付模式下基层医院脑卒中恢复期患者住院费用分析及精准控费研究

Analysis of Hospitalization Expenses and Precise Cost Control for Stroke Recovery Patients in Grassroots Hospitals under DRGs Payment Model

摘要: 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 < 手术费 < 床位费。住院费用结构变动度分析显示，2023年1季度结构变动度最大(22.58%)，而结构变动度最小的时间区间为2022年3季度(10.58%)。脑卒中恢复期康复治疗患者住院费用的最大影响的为治疗费用，检查费及药品费用次之，其贡献率分别为42.21%，19.80%、14.85%，3项费用贡献率总和占住院费用比例达到76.86%，而诊查费、床位费、手术费、材料费及其他费用均值均较低，结构贡献度比值均值在3%以下。住院天数、治疗方式、入院途径是患者住院费用影响总效应前三位的因素。结论：脑卒中恢复期康复治疗住院患者的疾病负担较重，治疗费用中占比居于首位，这与患者疾病性质有关，患者住院主要以康复治疗为主要目的，康复治疗项目费用占比高，可继续维持。但需进一步加强对检查费和药品费用等关联性高的费用因素的监控，在质控管理、诊疗监督工作中应对超标费用给予重点关注和监控。并积极采取措施提升诊疗服务质量的同时，切实减轻患者疾病经济负担。

Abstract: 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.