基于归纳法和专家咨询法的CHS&#x02014;DRG合并症、并发症分组探索&#x02014;&#x02014;以UPPP手术在DB33和DB35入组为例

李梦滢; 顼晋昆; 杨菁

doi:10.19546/j.issn.1674-3830.2023.9.011

中国医疗保险 ›› 2023, Vol. 0 ›› Issue (9) : 86-93. DOI: 10.19546/j.issn.1674-3830.2023.9.011

基于归纳法和专家咨询法的CHS—DRG合并症、并发症分组探索——以UPPP手术在DB33和DB35入组为例

李梦滢¹, 顼晋昆¹, 杨菁²

作者信息 +

Grouping of CHS—DRG Complications and Comorbidities Based on Inductive Method and Experts Consulting Method——Taking UPPP Surgery as an Example for DB33 and DB35 Enrollment

Author information +

文章历史 +

摘要

目的: 探讨UPPP手术在DB33组和DB35组的优化分组方式。方法: 以C医院CHS—DRG正式付费一周年来实际入组的55例UPPP手术患者为例,（1）描述性统计UPPP手术现行分组的平均住院天数、次均费用;（2）基于归纳法分别总结分入合并症组（DB33）和非合并症组（DB35）的诊断信息;（3）通过专家咨询法判断55例UPPP手术病案首页记录的79个诊断对医疗资源消耗的影响;（4）根据UPPP手术费用消耗特点,重新进行分组,并比较两组的变异系数（CV）与总体方差减少系数（RIV）。结果: （1）UPPP手术DB35组的次均费用反而高于DB33组;（2）有且仅有需合并其他手术的诊断将使得DB35组支付标准增加20%以上（大于等于3119.60元）;（3）以需合并其他手术/操作为分组依据重新分组,新分组RIV值从0.02升至0.58。结论: 应根据病种特点,适当调整合并症并发症分组策略,考虑在手术/操作病组中以合并手术/操作进行分组。

Abstract

Objective: The paper explores the optimal grouping method for UPPP surgery in the DB33 and DB35 groups. Methods: We take 55 patients enrolled in UPPP surgery during the one-year anniversary of CHS—DRG official payment at C hospital as an example. (1) Descriptive statistics were conducted on the average days of hospitalization and average cost per visit in the current group of UPPP surgery. (2) We summarized the diagnostic information of the comorbidities group (DB33) and the non-comorbidities group (DB35) based on induction method. (3) Expert consultation method was used to determine the impact of 79 diagnoses from the first page of medical record on medical resource consumption. (4) Based on the cost consumption characteristics of UPPP surgery, we regroup and compare the coefficient of variation (CV) and overall variance reduction coefficient (RIV) between the two groups. Results: (1) The average cost of UPPP surgery in the DB35 group was actually higher than that in the DB33 group. (2) Diagnosis that only requires the combination of other surgeries will increase the payment standard for DB35 group by more than 20% (greater than 3119.60 yuan). (3) We regrouped the disease based on the need to accompany other surgeries or procedures, and the RIV value of the new group increased from 0.02 to 0.58. Conclusion: The grouping strategy for comorbidities and complications should be adjusted appropriately based on the characteristics of the disease, and consideration should be given to grouping by combining surgeries or procedures in the surgical or operational disease group.

导出引用

李梦滢, 顼晋昆, 杨菁. 基于归纳法和专家咨询法的CHS—DRG合并症、并发症分组探索——以UPPP手术在DB33和DB35入组为例[J]. 中国医疗保险. 2023, 0(9): 86-93 https://doi.org/10.19546/j.issn.1674-3830.2023.9.011

Grouping of CHS—DRG Complications and Comorbidities Based on Inductive Method and Experts Consulting Method——Taking UPPP Surgery as an Example for DB33 and DB35 Enrollment[J]. China Health Insurance. 2023, 0(9): 86-93 https://doi.org/10.19546/j.issn.1674-3830.2023.9.011

中图分类号： F840.684C913.7

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