目的: 分析探讨DRG超支组患者住院费用的内部构成及相关费用变动情况,为医院优化费用结构、加强精细化管理提供数据支持。方法: 收集2022年4月至6月某三级肿瘤专科医院的恶性肿瘤次均住院超支金额排位前20%的病例（共计14个DRG组）住院基本费用信息,进行结构变动度分析及新灰色关联分析。结果: 超支比最高的3个组是RB21、RU11、ES33组,药品费用、影像及化验检查费用共同构成住院费用的最主要部分。对比各DRG组的超支病例和正常营收病例,结构构成存在不同程度的差异,RB21、XJ13、ER15组超支病例的药品费用占比相较正常组增加均超过20%,RC15组治疗费用占比增加53.52%。在不同的DRG组,各项费用对次均住院费用的结构变动贡献率也存在差异,各项费用和住院费用的关联程度最高的为药品费用（0.790）,其次为治疗费用（0.750）和耗材费用（0.736）。结论: 需探索通过临床论证后进行病组的再次优化,积极调整不同病种的权重,进一步精细化DRG的分组构成。
Abstract
Objective: The analysis explores the internal composition of inpatient costs and related cost changes of patients in the overspending DRG groups, providing data support for optimizing the cost structure and fine management of hospitals. Methods: The basic hospitalization cost information of the top 20% overspending cases ( a total of 14 DRGs) with malignant tumors from a tertiary oncology hospital from April to June 2022 was collected for degree of structural variation and new gray correlation analysis. Results: The three groups with the highest overspending ratios are RB21, RU11, and ES33, showing that drug costs and image and laboratory costs constituted the most important component of hospitalization costs. There were varying degrees of differences in the structural composition between the overspending cases and normal revenue cases in each DRG, and the drug cost ratios of overspending cases in RB21, XJ13, and ER15 groups increased by more than 20% compared with the normal group. The treatment cost ratio increased by 53.52% in the RC15 group. There were differences in the contribution rate of various types of costs to the structural change of the average hospitalization cost in different DRG groups. The highest degree of association between each cost and hospitalization cost was drug costs (0.790), followed by treatment costs (0.750) and consumables costs (0.736). Conclusion: It is necessary to explore the re-optimization of disease groups through clinical validation, and actively adjust the weights of different disease to further refine the composition of DRG.
关键词
恶性肿瘤 /
住院费用 /
新灰色关联分析 /
结构变动度分析
Key words
malignant tumors /
inpatient costs /
new gray correlation analysis /
degree of structural variation analysis
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基金
天津医科大学医院管理创新研究项目“DRG 付费下恶性肿瘤日间诊疗精细化管理模式研究”（2021YG10）; 天津医科大学医院管理创新研究项目“临床急需进口药政策下医疗管理模式研究 ”（2021YG11）; 天津市卫生健康科技项目（TJWJ2021QN025）; 天津医科大学医院管理创新研究项目“基于循证医学和Kaiser模型对抗肿瘤药临时采购管理工作的持续改进”（2023YG18）
