DRG/DIP支付改革背景下手术室医用耗材成本管控：管理策略、评价指标与研究展望

Cost Control of Medical Consumables in the Operating Room under DRG/DIP Payment Reform: Management Strategies, Evaluation Indicators, and Research Prospects

摘要: 目的：梳理DRG/DIP支付改革背景下手术室医用耗材成本管控的主要问题、管理策略和评价指标，并分析标准化、智能化与协同化管理之间的联系。方法：采用叙述性文献综述方法，检索中英文数据库并查阅相关政策文件。本文选择与手术室耗材管理直接相关、来源可以核验且内容较完整的资料，按照支付与成本问题、标准化管理、智能化管理、协同管理、实施障碍与应对策略和效果评价进行归纳。结果：现有研究主要从三个方面开展管理。目录和品规管理、术式耗材包、偏好卡及器械包优化有助于减少不合理的使用差异；UDI、RFID、智能柜和多系统连接可以提高账实一致性、患者关联和追溯效率；多部门共同参与有助于推动管理规则落实。现有研究多来自单家医院，研究设计以实施前后比较为主，成本口径也不完全一致。部分研究对患者安全、人员负担、实施成本和长期效果关注不足。此外，组织文化、技术集成、人员培训与工作负担、供应商关系以及评价与持续性维护是管理策略落地的常见障碍，现有文献提示了相应的应对方向。结论：手术室耗材管理不能只以费用下降作为评价标准。医院应以患者安全和临床需要为前提，通过标准化明确规则，通过智能化提供数据，并通过协同化推动实际改进。后续评价还应同时考虑病例风险、成本、效率、质量和人员负担。

Abstract: Objective: To review the main problems, management strategies, and evaluation indicators of medical consumable cost control in the operating room under the DRG/DIP payment reform, and to analyze the relationships among standardization, intelligent management, and collaborative management. Methods: A narrative literature review was adopted. Chinese and English databases were searched and relevant policy documents were reviewed. Materials directly related to operating room consumable management with verifiable sources and relatively complete content were selected and summarized under six themes: payment and cost issues, standardized management, intelligent management, collaborative management, implementation barriers and coping strategies, and outcome evaluation. Results: Existing studies mainly carried out management from three aspects. Formulary and specification management, procedure-based consumable kits, preference cards, and instrument tray optimization helped reduce unjustified variation in use; UDI, RFID, smart cabinets, and multi-system integration improved the consistency between accounts and physical inventory, patient association, and traceability; and multi-department collaboration helped promote the implementation of management rules. Most existing studies were conducted in single hospitals with before-after designs, and the cost definitions were not fully consistent. Some studies paid insufficient attention to patient safety, staff burden, implementation cost, and long-term effects. In addition, organizational culture, technical integration, staff training and workload, supplier relationships, and evaluation and sustainability were common barriers to the implementation of management strategies, and the existing literature suggested corresponding coping directions. Conclusion: Operating room consumable management should not be evaluated solely by cost reduction. Hospitals should take patient safety and clinical needs as the premise, clarify rules through standardization, provide data through intelligent management, and promote practical improvement through collaboration. Future evaluation should simultaneously consider case risk, cost, efficiency, quality, and staff burden.