目的: 运用结构变动度分析DRG病组结构,为发现医疗机构违规调整病组提供数据分析方法。方法: 运用结构变动值、结构变动度和结构变动贡献率等评价指标,对杭州市2020年和2021年345家医疗机构DRG病组数据以及违规病例数进行分析。结果: 随着区间内医疗机构的结构变动贡献率提升,该区间内医疗机构的违规病例数占住院总病例数的比例呈现递增趋势,病组结构变动贡献率的增加可以在一定程度上体现医疗机构违规情况的增长趋势,两者呈正相关趋势。结论: 采用结构变动度分析DRG病组结构可以反映医疗机构的违规行为,在DRG支付方式改革中对加强病案监管具有一定应用价值。

Objective: The paper analyzes the structure of DRG groups with the degree of structural variation to provide a data analysis method for finding out the hospital's illegal adjustment of DRG groups. Methods: Using the evaluation indicators of values of structure variation|degree of structure variation and contribution rate of structure variation|the DRG groups and the number of violation cases of 345 hospitals in Hangzhou in 2020 and 2021 were analyzed. Results: With the increase of contribution rate of structure variation in the interval|the proportion of illegal cases in the total number of inpatient cases in the interval showed an increasing trend. The increase of contribution rate of structure variation in the disease group could reflect the growth trend of violations in medical institutions to a certain extent and there was a positive correlation between them. Conclusion: The analysis of DRG groups structure with the degree of structure change can reflect violations of hospitals|which can be applied in strengthening the medical records supervision in the DRG payment reform.