Page 20 - 《中国药房》2024年12期

DRG支付方式下药径在某三甲医院骨科的实施效果评价 Δ

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王 佳 ，刘 锋 ，汪 磊 ，陈 敏 ，高寅巳 ，秦 侃 （1.安徽医科大学第三附属医院药学部，合肥 230061；
2.安徽医科大学第三附属医院质量与绩效管理处，合肥 230061；3.皖南医学院第一附属医院医保办，安徽
芜湖 241001；4.安徽医科大学第三附属医院病案室，合肥 230061；5.安徽医科大学第三附属医院事业发展
处，合肥 230061）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2024）12-1426-05
DOI 10.6039/j.issn.1001-0408.2024.12.03

摘 要 目的 为促进疾病诊断相关分组（DRG）支付改革、推动医院精细化运营管理及临床合理用药提供参考。方法 以我院（安
徽医科大学第三附属医院）骨科为研究对象，基于循证药学证据，构建并实施针对该科室DRG病种的药物治疗临床路径（简称“药
径”），将符合DRG病种的患者均纳入药径管理，同一DRG病组患者“同病同治”。采用分段回归时间序列模型，分析实施药径管
理对我院骨科医疗服务能力、医疗服务效率和医疗服务质量的影响。结果 药径干预时，我院骨科的平均住院日、住院次均费用、
药占比、住院次均药费和抗菌药物使用强度均显著缩短/下降，医疗服务收入占比和医嘱合格率显著上升（P＜0.05）；药径干预后，
平均住院日和抗菌药物使用强度均继续下降，医嘱合格率也继续显著上升（P＜0.05）。结论 实施药径可提高医疗服务质量，提升
医院运营效率，降低医疗费用支出，推动医院精细化管理体系建设。
关键词 药物治疗临床路径；疾病诊断相关分组；分段回归时间序列模型；间断时间序列分析；骨科
Evaluation of the implementation effectiveness of the medication pathway in the orthopedic department of
a tertiary hospital under DRG payment
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WANG Jia ，LIU Feng ，WANG Lei ，CHEN Min ，GAO Yinsi ，QIN Kan（1. Dept. of Pharmacy， the Third
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Affiliated Hospital of Anhui Medical University， Hefei 230061， China；2. Dept. of Quality and Performance
Management， the Third Affiliated Hospital of Anhui Medical University， Hefei 230061， China；3. Dept. of
Medical Insurance， the First Affiliated Hospital of Wannan Medical College， Anhui Wuhu 241001， China；
4. Medical Records Room， the Third Affiliated Hospital of Anhui Medical University， Hefei 230061， China；
5. Dept. of Business Development， the Third Affiliated Hospital of Anhui Medical University， Hefei 230061，
China）
ABSTRACT OBJECTIVE To provide reference for improving the disease diagnosis related groups （DRG） payment reform，
promoting refined hospital operation and management and rational drug use. METHODS Taking the orthopedic department of our
hospital （the Third Affiliated Hospital of Anhui Medical University） as the research object， based on evidence-based medicine， a
medication clinical pathway （hereinafter referred to as medication pathway） for DRG diseases in this department was constructed
and implemented. All patients who met the DRG disease were included in the medication path management， and the patients in the
same DRG disease group were treated with the same treatment method. Segmented regression model （SRM） was adopted to analyze
the effects of medication pathway on the medical service capacity， efficiency and quality of our hospital. RESULTS During the
implementation of medication pathway， significant decreases were observed in average length of hospital stay， cost per
hospitalization， the proportion of medication expenses， medication cost per hospitalization and defined daily dose； the proportion of
medical service revenue and the qualified rate of medical orders significantly increased （P＜0.05）. After the implementation of
medication pathway， the average length of hospital stay and defined daily dose continued to decrease， and the qualified rate of
medical orders also continued to significantly increase （P＜0.05）. CONCLUSIONS The implementation of medication pathway
enhances the quality of medical services， improves operational efficiency， reduces medical expenses， and contributes to the
development of a refined hospital management system.
KEYWORDS medication pathway； disease diagnosis related groups； segmented regression model； interrupted time series
analysis； orthopedic department
Δ 基金项目 安徽省医疗卫生重点专科建设项目（No. 皖卫函
〔2021〕273号） 疾病诊断相关分组（diagnosis related group，DRG）
＊第一作者 副主任药师，硕士。研究方向：临床药学。电话：
是根据患者年龄、疾病诊断、治疗方式、疾病严重程度及
0551-62186166。E-mail：dmjiajia@126.com
# 通信作者 主任药师，硕士生导师。研究方向：临床药学。电话： 转归、资源消耗等因素，将病例分入若干诊断组进行管
[1]
0551-62183936。E-mail：qinkan99@163.com 理的一种病例组合分类方案 。我国 DRG 支付借鉴了

· 1426 · China Pharmacy 2024 Vol. 35 No. 12 中国药房 2024年第35卷第12期