基于变异系数评价重症医学科DRG分组效能研究

目的评价重症医学科DRG分组的效能,发现存在的问题,为DRG付费或绩效考核提供建议。方法采用DRG分组器获得样本医院2016―2019年出院患者的分组结果。在2555名重症医学科出院患者中选取病例数排名前5位的DRG组作为DRG研究组。在351148名全院出院患者中筛选出DRG研究组的所有病例。对入组同一个DRG组的患者,根据其所属的出院科室分为全院组(包括重症医学科和非重症医学科出院患者)和重症医学科组(仅包括重症医学科出院患者)。通过计算住院费用的变异系数评价全院组和重症医学科组的组内同质性。结果在同一个DRG组中,重症医学科出院患者组住院费用的变异系数低于全院出院患者组,即对于同一个DRG分组病种,重症医学科出院患者单独评价时组内住院费用的同质性更高。结论应用DRG付费或绩效考核时,针对重症医学科出院的患者应考虑细化DRG分组或调整分组权重,以便形成更加科学合理的疾病分组。

Evaluation of DRG Grouping Efficiency in Intensive Care Department based on Coefficient of Variation

Objective To evaluate the effectiveness of DRG grouping in Department of Critical Care Medicine,to find out existing problems,and provide suggestions for DRG payment or performance appraisal.Methods The DRG grouping was used to obtain the grouping results of discharged patients from the sample hospitals from 2016 to 2019.Among the 2555 discharged patients from the Department of Critical Care Medicine,the DRG group with the top 5 cases was selected as the DRG study group.All cases in the DRG study group were screened out of 351,148 discharged patients from the hospital.Patients in the same DRG group were divided into the whole hospital group(including patients discharged from the Department of Critical Care Medicine and non-critical medicine departments)and the Department of Critical Care Medicine group(including only patients discharged from the Department of Critical Care Medicine)according to the discharge department to which they belonged.The variable coefficient of hospitalization expenses was calculated to evaluate the intraclass homogeneity of the whole hospital group and the Department of Critical Care Medicine group.Results In the same DRG group,the variable coefficient of the hospitalization expenses of the discharged patients in the Department of Critical Care Medicine group was lower than that of the discharged patients in the whole hospital.That is to say,for the same DRG group,the intraclass homogeneity of hospitalization expenses in the group was higher when the patients discharged from the Department of Critical Care Medicine were evaluated separately.Conclusion When applying DRG payment or performance appraisal,for patients discharged from the Department of Critical Care Medicine,the DRG grouping should be refined or the group weight should be adjusted to form a more scientific and reasonable disease grouping.