【摘要】 目的:对产科剖宫产病例DRG的分组效果及费用的影响因素进行分析,为DRG付费改革及控制医疗费用提供依据。方法:统计分析样本医院5 940例剖宫产病例信息,采用变异系数、总体方差减小系数评价DRG的分组效果,通过单因素分析及多元逐步回归分析住院费用影响因素。结果:DRG的分组CV值均小于0.5,RIV值为9.40%;单因素分析发现:年龄、付费方式、麻醉方式、术前天数、住院天数、新生儿出生体重、并发症与合并症影响住院费用,差异具有统计学意义(P<0.05);逐步回归进一步分析显示:住院天数、付费方式、并发症与合并症、新生儿出生体重、麻醉方式、年龄是住院费用的主要影响因素。结论:剖宫产病例DRG的分组能客观反映医疗资源消耗水平;医院应以DRG付费改革为突破口,推进临床路径管理,规范诊疗流程,缩短住院天数,有效控制医疗费用不合理增长。更多还原

【Abstract】 Objective:Analyze the effect of DRG grouping and cost influencing factors of obstetric cesarean section cases,and provide a basis for DRG payment reform and control of medical expenses.Methods:The information of 5 940 cesarean section cases in a tertiary hospital was statistically analyzed.The coefficient of variation and the overall variance reduction coefficient were used to evaluate the effect of DRG grouping.The influencing factors of hospitalization expenses were analyzed through single factor analysis and multiple stepwise regressions.Results:The CV value of the DRG group was less than 0.5,and the RIV value was 9.4%.Univariate analysis found that age,payment methods,anesthesia methods,days before surgery,days of hospitalization,birth weight of newborns,complications and comorbidities affect hospitalization costs,differences are statistically significant(P<0.05);stepwise regression further analysis showed that the length of hospital stay,payment methods,complications and comorbidities,newborn birth weight,anesthesia methods and age were the main influencing factors of hospitalization expenses.Conclusion:The DRG grouping of cesarean section women can objectively reflect the level of medical resource consumption;hospitals should use the opportunity to reform the DRG payment method to vigorously promote clinical path management,standardize the diagnosis and treatment process,shorten the length of hospitalization,and effectively control medical expenses.更多还原