DRG付费方式和临床路径管理对脑梗死患者住院费用影响的联合作用分析

doi:10.3969/j.issn.1673-5765.2025.02.017

中国卒中杂志 ›› 2025, Vol. 20 ›› Issue (2): 253-260.DOI: 10.3969/j.issn.1673-5765.2025.02.017

• 医管园地 • 上一篇

DRG付费方式和临床路径管理对脑梗死患者住院费用影响的联合作用分析

王玲玲¹，王晓楠¹，王真明¹，周道平²，张现格³，王文君¹

1 合肥 230041 安徽省第二人民医院质量控制处
2 安徽省第二人民医院肿瘤科
3 安徽医科大学卫生管理学院

收稿日期:2024-07-17 出版日期:2025-02-20 发布日期:2025-02-20
通讯作者: 王文君 18361878@qq.com
基金资助:
安徽省中医药传承创新科研项目（2024CCCX298）
安徽省高等学校科学研究项目（2022AH050647）

Analysis of the Combined Effect of DRG Payment and Clinical Pathway Management on the Hospitalization Cost of Patients with Cerebral Infarction

WANG Lingling¹, WANG Xiaonan¹, WANG Zhenming¹, ZHOU Daoping², ZHANG Xian’ge³, WANG Wenjun¹

1 Medical Quality and Control Department, Anhui No.2 Provincial People’s Hospital, Hefei 230041, China
2 Oncology Department, Anhui No.2 Provincial People’s Hospital, Hefei 230041, China
3 School of Health Management, Anhui Medical University, Hefei 230032, China

Received:2024-07-17 Online:2025-02-20 Published:2025-02-20
Contact: WANG Wenjun, E-mail: 18361878@qq.com

摘要/Abstract

摘要： 目的探讨疾病诊断相关分组（diagnosis related groups，DRG）付费制度和临床路径管理对脑梗死患者住院费用的控制效果及其联合作用。
方法选取安徽省某三级甲等医院2022年11月1日—2023年10月31日出院主诊断为脑梗死的住院患者为研究对象，结合病案首页及合肥市医保中心医疗保障信息系统反馈，将患者分为非DRG结算非临床路径组、只采取DRG结算组、只纳入临床路径组、DRG结算联合临床路径组，采用单因素分析探讨不同组别患者的基线特征及费用差异。调整年龄、性别、入院途径、手术或操作情况、转科情况、病危病重情况、患者来源地、住院时间、支付方式、主要治疗结果等进行多重线性回归分析，探讨DRG付费制度和临床路径管理对脑梗死患者住院费用的影响及其联合作用。
结果共纳入脑梗死住院患者5461例，结果显示纳入临床路径管理、采取DRG结算的患者住院费用较低。多重线性回归分析结果显示，临床路径与DRG之间有交互作用，且临床路径降低了DRG的控费效果（t=2.63，P=0.01）。临床路径与DRG付费方式的联合作用结果显示与非DRG结算非临床路径组患者相比，DRG结算联合临床路径组患者或只采取DRG结算组患者的住院费用自然对数均降低了0.06（P<0.01)，而只纳入临床路径组患者的住院费用自然对数降低了0.04（P<0.01)。
结论 DRG付费方式的降费力度强于临床路径管理，而未结合DRG付费方式的临床路径管理会降低DRG付费方式的控费效果，DRG付费方式需要与临床路径管理深度结合，根据不同病组的质量情况寻找费用的平衡点，以此作为调整优化临床路径的标杆。

文章导读： 本文通过构建3个线性回归模型探讨DRG付费方式与临床路径对脑梗死患者住院费用的联合效应，结果显示，DRG付费方式的降费力度强于临床路径，而未结合DRG付费方式的临床路径会降低DRG付费方式的控费效果，DRG付费方式需与临床路径深度结合。

关键词: 疾病诊断相关分组; 临床路径; 住院费用

Abstract: Objective To explore the control effect of the diagnosis related groups (DRG) payment system and clinical pathway management on the hospitalization cost of patients with cerebral infarction, as well as their combined effect.
Methods Inpatients diagnosed with cerebral infarction from November 1, 2022 to October 31, 2023 in a grade-A tertiary hospital in Anhui Province were selected as the study objects. Based on the data from medical record homepage and feedback from the Hefei medical insurance information system, patients were divided into four groups, including the non-DRG payment and non-clinical pathway group, the only DRG payment group, the only clinical pathway group, and the DRG payment combined with clinical pathway group. Univariate analysis was used to explore the baseline characteristics and cost differences among different groups. After adjusting for factors such as age, gender, admission route, surgical or operational status, transfer status, disease condition, patient origin, length of hospital stay, way of payment, and main treatment outcome, multiple linear regression analysis was performed to explore the effect of DRG payment system and clinical pathway management on the hospitalization cost of cerebral infarction patients and their combined effects.
Results A total of 5461 patients with cerebral infarction were included in the study. The results showed that patients included in clinical pathway management and those who adopted DRG payment had lower hospitalization cost. The results of multiple linear regression analysis showed that there was an interaction between clinical pathway and DRG, and clinical pathway reduced the effect of DRG on controlling hospitalization cost (t=2.63, P=0.01). The results of the combined effect of clinical pathway and DRG payment showed that compared to patients in the non-DRG payment and non-clinical pathway group, the natural logarithm of hospitalization cost of patients in the DRG payment combined with clinical pathway group or those in the only DRG payment group were reduced by 0.06 (P<0.01), while the natural logarithm of hospitalization cost in the only clinical pathway group was reduced by 0.04 (P<0.01).
Conclusions The effect of DRG payment on controlling hospitalization cost is stronger than that of clinical pathway management, and clinical pathway management not combined with DRG payment will reduce the effect of DRG payment on controlling hospitalization cost. The DRG payment needs to be deeply integrated with clinical pathway management, and the balance point of the cost should be found according to the quality of different disease groups, which can serve as a benchmark for adjusting and optimizing the clinical pathway.

Key words: Diagnosis related groups; Clinical pathway; Hospitalization cost

中图分类号:

王玲玲, 王晓楠, 王真明, 周道平, 张现格, 王文君. DRG付费方式和临床路径管理对脑梗死患者住院费用影响的联合作用分析[J]. 中国卒中杂志, 2025, 20(2): 253-260.

WANG Lingling, WANG Xiaonan, WANG Zhenming, ZHOU Daoping, ZHANG Xian’ge, WANG Wenjun. Analysis of the Combined Effect of DRG Payment and Clinical Pathway Management on the Hospitalization Cost of Patients with Cerebral Infarction[J]. Chinese Journal of Stroke, 2025, 20(2): 253-260.

参考文献

[1] CHEN H L，ZHAN Y，ZHANG K M，et al. The global，regional，and national burden and trends of infective endocarditis from 1990 to 2019：results from the global burden of disease study 2019[J/OL]. Front Med（Lausanne），2022，9：774224[2024-06-24]. https://doi.org/10.3389/fmed.2022.774224.
[2] DEWEY H M，THRIFT A G，MIHALOPOULOS C，et al. Lifetime cost of stroke subtypes in Australia：findings from the North East Melbourne stroke incidence study（NEMESIS）[J]. Stroke，2003，34（10）：2502-2507.
[3] 姚奕婷，翁一冰，邓婕，等. DRG发展与应用回顾及付费标准研究综述[J]. 中国卫生经济，2018，37（1）：24-27.
YAO Y T，WENG Y B，DENG J，et al. Review on domestic and foreign development，application of the diagnosis related groups and the research of payment standard[J]. Chinese Health Economics，2018，37（1）：24-27.
[4] 莫夏丽，黄鹏，李红，等. 基于疾病诊断相关分类付费的临床路径研究应用概述[J]. 内科，2021，16（4）：504-506.
MO X L，HUANG P，LI H，et al. Overview of the application of clinical pathway research based on disease diagnosis related classification payment[J]. Internal Medicine，2021，16（4）：504-506.
[5] 朱晓丹，李琰华，王静华，等. 腰痛为表现的未分化疾病的全科临床路径的有效性研究[J]. 中国全科医学，2024，27（19）：2352-2356.
ZHU X D，LI Y H，WANG J H，et al. Study of the effectiveness of general practice clinical pathway for medically unexplained disease manifested by low back pain[J]. Chinese General Practice，2024，27（19）：2352-2356.
[6] 邱晶青，汤天凤，薛缪群，等. DRG对原发性支气管肺癌临床路径实施效果的优化研究[J]. 江苏卫生事业管理，2018，29（9）：1033-1037.
QIU J Q，TANG T F，XUE M Q，et al. Research on optimization of clinical pathway effect of DRG：based on primary bronchial lung cancer[J]. Jiangsu Health System Management，2018，29（9）：1033-1037.
[7] 张世冉. 医保支付方式改革背景下医疗住院费用影响因素研究——以两种病种为例[D]. 南昌：江西中医药大学，2023.
ZHANG S R. Analysis of factors influencing medical inpatient costs in the context of medical insurance payment reform—an example of two types of illnesses[D]. Nanchang：Jiangxi University of Chinese Medicine，2023.
[8] 关翎，郭昱君，杨燕绥，等. 临床路径优化卫生资源的分析研究[J]. 中国卫生质量管理，2020，27（1）：39-43.
GUAN L，GUO Y J，YANG Y S，et al. Analysis on optimizing health resources by clinical pathway[J]. Chinese Health Quality Management，2020，27（1）：39-43.
[9] 陈凤磊，梁冰，钱静，等. DRG付费改革对广西某三甲医院患者住院费用影响研究[J]. 中国医院，2023，27（1）：53-55.
CHEN F L，LIANG B，QIAN J，et al. Research on the changes in patients’ hospitalization expenses after the DRG payment reform in a grade Ⅲ level A hospital in Guangxi[J]. Chinese Hospitals，2023，27（1）：53-55.
[10] TRIMARCHI L，CARUSO R，MAGON G，et al. Clinical pathways and patient-related outcomes in hospital-based settings：a systematic review and meta-analysis of randomized controlled trials[J/OL]. Acta Biomed，2021，92（1）：e2021093[2024-06-24]. https://doi.org/10.23750/abm.v92i1.10639.
[11] DUNNACK H J，MONTANO A L. Interprofessional clinical pathway program effects on patient outcomes in the setting of neutropenic fever：an integrative review[J/OL]. Eur J Oncol Nurs，2021，52：101974[2024-06-24]. https://doi.org/10.1016/j.ejon.2021.101974.
[12] 古德彬，李梦滢，沈际勇. 临床路径管理对脑梗死患者住院费用的影响研究[J]. 卫生经济研究，2023，40（6）：30-34.
GU D B，LI M Y，SHEN J Y. Study on the influence of clinical pathway management on hospitalization expenses of patients with cerebral infarction[J]. Health Economics Research，2023，40（6）：30-34.
[13] RASKOLNIKOV D，HALL M K，NGO S D，et al. Strategies to optimize nephrolithiasis emergency care（STONE）：prospective evaluation of an emergency department clinical pathway[J/OL]. Urology，2022，160：60-68[2024-06-24]. https://doi.org/10.1016/j.urology.2021.09.028.
[14] 接纯纯. 公立医院临床路径与DRG关系的实证研究[D]. 合肥：安徽医科大学，2023.
JIE C C. An empirical study of the relationship between clinical pathways and DRG in public hospitals[D]. Hefei：Anhui Medical University，2023.

DRG付费方式和临床路径管理对脑梗死患者住院费用影响的联合作用分析

Analysis of the Combined Effect of DRG Payment and Clinical Pathway Management on the Hospitalization Cost of Patients with Cerebral Infarction

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 2

编辑推荐

Metrics

[1]	张心邈, 潘岳松, 向祥龙, 王拥军, 孟霞. 早期临床路径干预改善卒中医疗服务质量关键绩效指标研究[J]. 中国卒中杂志, 2022, 17(09): 977-984.
[2]	张豪，王伊龙，白波，潘岳松，张昊. 医改政策对脑梗死患者住院费用影响的研究[J]. 中国卒中杂志, 2016, 11(07): 607-612.