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

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。

关键词: 疾病诊断相关分组; 临床路径; 住院费用