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某院药品消耗指数与DRG超支的相关性及阈值效应分析
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杨香瑜 ，李璐璐，余子珩，张韶辉（武汉市第一医院药学部，武汉 430022）
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中图分类号 R95 文献标志码 A 文章编号 1001-0408（2025）01-0113-04
DOI 10.6039/j.issn.1001-0408.2025.01.19

摘 要 目的 探讨药品消耗指数与疾病诊断相关分组（DRG）超支的相关性，为医院优化费用结构、加强精细化管理提供依据。
方法 以某三级甲等医院2023年9－11月DRG入组病例为研究资料，分别采用Logistic回归模型、限制性立方样条（RCS）模型分
析药品消耗指数与DRG超支的相关性以及阈值效应。同时基于药品消耗指数开展合理用药点评，进行精准控费及管理，并分析
管控前（2023年1－6月）与管控后（2024年1－6月）全院主要药事指标变化情况。结果 多因素Logistic回归分析结果显示，住院
天数长、药品消耗指数高、转科、合并糖尿病是DRG超支的危险因素（P＜0.05）。RCS模型结果表明，药品消耗指数与DRG超支呈
非线性关系，当药品消耗指数≥0.64时，药品消耗指数与DRG超支风险呈正相关（P＜0.05）。与管控前同期比较，管控后的次均医
疗费用、次均药品费用、药品消耗指数均显著下降（P＜0.01）。结论 药品消耗指数是DRG超支的危险因素，其与DRG超支存在非
线性关系和阈值效应。各医院可结合实际药品使用情况、疾病谱特征以及成本控制目标，综合考虑医疗质量、患者需求和医保支
付能力等因素，设定合理的阈值并实施动态监测与干预，以实现药品使用的精准管控。
关键词 药品消耗指数；疾病诊断相关分组；Logistic回归；限制性立方样条模型；阈值效应

Analysis of the correlation of drug consumption index with DRG overspending and its threshold effect in a
hospital
YANG Xiangyu，LI Lulu，YU Ziheng，ZHANG Shaohui（Dept. of Pharmacy， Wuhan No. 1 Hospital， Wuhan
430022， China）

ABSTRACT OBJECTIVE To explore the correlation between drug consumption index and diagnosis related groups （DRG）
overspending cases， and provide a basis for hospitals to optimize the cost structure and strengthen the refined management.
METHODS Based on the data of DRG patients enrolled in a third-grade class A hospital from September to November 2023， the
multivariate Logistic regression model and restricted cubic spline （RCS） model were used to analyze the correlation of drug
consumption index with DRG overspending cases and its threshold effect， respectively. At the same time， rational drug use
evaluation was conducted based on the drug consumption index， precise cost control and management were carried out， and the
changes in the main pharmaceutical indicators of the whole hospital were analyzed before control （January-June 2023） and after
control （January-June 2024）. RESULTS The results of multivariate Logistic regression analysis showed that long hospitalization
days， high drug consumption index， transfer to other departments and combined diabetes mellitus were the risk factors for DRG
overspending （P＜0.05）. The results of the RCS model showed that the drug consumption index had a non-linear relationship with
DRG overspending. When the drug consumption index was ≥0.64， the drug consumption index was positively correlated with the
risk of DRG overspending（P＜0.05）. Compared with the same period before the control， medical cost per time， drug cost per time
and drug consumption index decreased significantly after the control （P＜0.01）. CONCLUSIONS The drug consumption index is a
risk factor for DRG overruns， there is a non-linear relationship and threshold effect between it and DRG overruns. Each hospital
can set a reasonable threshold and implement dynamic monitoring and intervention by comprehensively considering the actual drug
usage， disease spectrum characteristics， and cost control targets， as well as factors such as medical quality， patient needs， and the
payment capacity of medical insurance， which can effectively achieve precise control over drug usage.
KEYWORDS drug consumption index； diagnosis related groups； Logistic regression； restricted cubic spline model； threshold
effect

疾病诊断相关分组（diagnosis related groups，DRG） 付方式改革的持续深入，DRG付费工作的考核评价指标
支付方式以疾病诊断为基础，通过科学分组建立动态价 体系也在不断完善，一些新指标、新概念也随之出现，尤
格调整机制和运行监督机制，推动公立医院降本增效， 其是关于资源使用效率和 DRG 费用控制的指标，如费
已成为医院高质量发展的内驱力之一 [1―2] 。随着医保支 用消耗指数的分项——药品消耗指数和耗材消耗指数
等，这些结构消耗指数将打破传统药占比、耗占比用于
Δ 基金项目 武汉药学会科研基金项目（No.WHPA202302088） [3―4]
＊第一作者 主管药师，硕士。研究方向：临床药学、药事管理。 医院考核的单一性和片面性 。如何科学运用DRG工
具定位超支主要因素从而进行精准控费及资源配置，已
E-mail：358752306@qq.com
[5]
# 通信作者 副主任药师，博士。研究方向：临床药学。E-mail： 成为医院精细化管理的新契机 。对于药品消耗指数的
zshtjmu@hotmail.com 进一步研究可以找到病组费用消耗指数差异的具体原

中国药房 2025年第36卷第1期 China Pharmacy 2025 Vol. 36 No. 1 · 113 ·