西部某大型综合三甲医院2020-2022年住院患者病种分析

【作者】 李尚乐； 唐仲杰； 赵正斌； 景彦梅； 胡芳兵； 张轶； 张立婷；

【机构】 兰州大学第一医院； 四川大学华西公共卫生学院/华西第四医院HEOA Group；

【摘要】 目的:在全面取消药品加成和执行耗材带量采购背景之下,基于费用结构对住院患者病种进行分类,为针对性控制耗占比提供数据参考。方法:选取西部某大型综合三甲医院2020-2022年所有住院患者病案首页,提取医疗费用构成中各单项费用,以ICD-10前三位(即ICD-10类目)为病种划分标准,使用K-means聚类分析将患者病种进行分类,分析各类别病种的特点。结果:基于费用结构可将患者病种分为4类,2020年1类和3类病种、2021年3类病种和2022年1类病种均是耗占比较高的疾病分类,其中住院次数较高者以心血管疾病为主。讨论与建议:耗占比高既有病种本身的属性使然,也有耗材使用不得当的原因,应当规范病种的临床诊疗路径,在医院运营实践中加强耗材相关绩效考核,在耗材采购和使用过程中严格把关,有效控制耗材费用支出。更多还原

【Abstract】 Objective Under the background of completely abolishing drug addition and implementing the purchase of consumables, the inpatient diseases are classified based on the cost structure,which provides data reference for targeted control of the proportion of consumables. Methods The first page of medical records of all inpatients in a large comprehensive tertiary hospital in western China from 2020 to 2022 was selected to extract the individual expenses in the composition of medical expenses. The top three ICD-10( ICD-10 category) were used as the classification criteria of diseases. K-means clustering analysis was used to classify the diseases of patients and analyze the characteristics of various diseases. Results Based on the cost structure, the patient’s diseases can be divided into four categories. Class 1 and Class 3 diseases in 2020, Class 3 diseases in 2021 and Class 1 diseases in 2022 are all disease classifications with high consumption, among which cardiovascular diseases are the main ones with higher hospitalization times. Conclusion The high proportion of consumption is due to the attributes of the disease itself, and there are also reasons for the improper use of consumables.The clinical diagnosis and treatment path of the disease should be standardized, and the performance appraisal of consumables should be strengthened in the hospital operation practice.Strict control in the process of purchasing and using consumables, and effective control of consumables expenses.更多还原