Page 119 - 《中国药房》2022年17期

DRG背景下临床药师参与消化内科药事精细化管理的实践 Δ

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伍渊麟 ，陈世耕 ，鲜秋婉 ，毕小婷 ，张 攀 ，刘 耀 （1.陆军特色医学中心药剂科，重庆 400042；2.陆军特
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色医学中心医研部医保办，重庆 400042；3.陆军特色医学中心医研部医疗办，重庆 400042）
中图分类号 R95 文献标志码 A 文章编号 1001-0408（2022）17-2157-05
DOI 10.6039/j.issn.1001-0408.2022.17.22
摘 要 目的 探讨临床药师基于疾病诊断相关分组（DRG）参与消化内科住院患者药事精细化管理的成效。方法 选取我院消化
内科进入 DRG病组的出院患者为研究对象，比较临床药师参与消化内科药事精细化管理干预前（2019 年 4－12月）、干预后（2020
年4－12月、2021年4－12月）患者的DRG指标以及住院相关指标的变化情况；对入组例数排名靠前的重点DRG病组和超出支付
标准的DRG病例进行重点分析，探究各项费用的偏离情况；借助处方医嘱点评手段，对每个DRG病组中超过标杆医院3倍支付标
准的病例开展用药合理性评价。结果 在干预第1年，消化内科病例组合指数值升高，费用消耗指数、时间消耗指数、平均住院日均
显著降低（P＜0.01）；在干预第2年，消化内科病例总权重升高，费用消耗指数、时间消耗指数、次均住院费用、次均药品费用和平均
住院日均较干预前显著降低（P＜0.01）。在入组例数排名前5位的DRG 病组中，在干预第1年，GZ15、GZ13和GJ15病组次均药品
费用均显著下降；在干预第 2 年，GZ15、GZ13、GJ15 和 GJ13 病组次均住院费用和次均药品费用均较干预前显著下降（P＜0.01）。
临床药师对DRG超支病例进行干预后，超支率显著下降（P＜0.001）。结论 DRG背景下，我院药事精细化管理措施取得了一定成
效，提高了临床用药的合理性，为医疗机构的费用控制和利用提供了新的切入点。
关键词 疾病诊断相关分组；临床药师；消化内科；药事精细化管理

Practice of clinical pharmacists participating in fine management of pharmaceutical affairs in
gastroenterology department based on DRG data
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WU Yuanlin ，CHEN Shigeng ，XIAN Qiuwan ，BI Xiaoting ，ZHANG Pan ，LIU Yao（1. Dept. of Pharmacy，
Army Specialty Medical Center，Chongqing 400042，China；2. Medical Insurance Office，Medical Research
Department of Army Special Medical Center，Chongqing 400042，China；3. Dept. of Medical Office，Medical
Research Department of Army Special Medical Center，Chongqing 400042，China）
ABSTRACT OBJECTIVE To explore the effect of clinical pharmacists participating in fine management of pharmaceutical
affairs among the inpatients in the department of gastroenterology based on diagnosis related groups（DRG）data. METHODS The
discharged patients in the gastroenterology department of our hospital were selected as the research objects to compare the changes
of DRG indicators and hospitalization related indicators before（from April to December 2019）and after（from April to December
2020 and from April to December 2021） pharmacists participating in fine management of pharmaceutical affairs in the
gastroenterology department. The key DRG with the highest number of enrolled cases and DRG cases of the total cost overrun were
analyzed to explore the deviation of various costs. The rationality of drug use was evaluated for the cases in each DRG that
exceeded the benchmark hospital payment standard by three times，with the help of prescription doctor’s advice review. RESULTS
In the first year of intervention，the case combination index value of gastroenterology department was increased，meanwhile，the
cost consumption index，time consumption index and average hospital stay were decreased significantly（P＜0.01）. In the second
year of intervention，total weight of the cases in gastroenterology department was increased，while cost consumption index，time
consumption index，hospitalization cost per time，drug cost per time and average hospital stay were all decreased significantly，
compared with before intervention（P＜0.01）. Among the top five DRG，the drug cost per time in the GZ15，GZ13 and GJ15 were
all decreased significantly in the first year of intervention；hospitalization cost per time and drug cost per time in the GZ15，GZ13，
GJ15 and GJ13 were all decreased significantly in the second year of intervention（P＜0.01）；after the intervention of clinical
pharmacists in DRG over-expenditure cases，the over-expenditure rate decreased significantly（P＜0.001）. CONCLUSIONS The
fine management of pharmaceutical affairs in our hospital has achieved certain results and promotes the rationality of clinical drug
use，and provides a new entry point for the cost control and
Δ 基金项目 重庆市临床药学重点专科建设项目（No.渝卫办发
utilization of medical institutions under the background of
〔2020〕68号）
DRG.
＊第一作者 药师，硕士。研究方向：临床药学、药物经济学。
KEYWORDS diagnosis related groups；clinical pharmacist；
E-mail：wuyuanlin8023@163.com
gastroenterology deaprtment；fine management of pharmaceu-
# 通信作者 副主任药师，硕士生导师，博士。 研究方向：药事管
理及合理用药。 E-mail：swhliuyao@163.com tical affairs

中国药房 2022年第33卷第17期 China Pharmacy 2022 Vol. 33 No. 17 ·2157 ·