DRG支付下四川省特病单议病例的多维特征与关联因素研究OA

Objective To analyze the clinical characteristics,cost structure,and associated factors of separately discussed ca-ses under the Diagnosis-Related Groups(DRG)payment system in Sichuan Province from 2020 to 2021,and provide empirical evidence for improving the separately discussed case policy and optimizing DRG payment reform.Methods Data of DRG settlement cases in Sichuan Province from 2020 to 2021 were collected.Statistical analyses,including non-parametric tests and binary lo-gistic regression were conducted using Stata software.Results A total of 10,249 separately discussed cases were included,which were characterized by older age,longer hospital stays,and a significant concentration in tertiary hospitals.The average total cost per case in the separately discussed group(38,043.25 CNY)was 3.17 times that of the non-separately discussed group.The cost structure was dominated by drug costs(26.95％)and material/consumable costs(26.36％).Logistic regression showed that longer hospital stays(OR=41.197),treatment in tertiary hospitals(OR=5.126),advanced age(OR=1.354),and undergoing surgical procedures(OR=1.525)were major risk factors,whereas a higher DRG base point weight(OR=0.998)was negatively associated with the probability of being a separately discussed case.Conclusion The separately discussed case mechanism effectively identifies clinically complex cases and provides a necessary reimbursement channel for the treatment of se-verely ill patients.However,problems still remains,including inadequate control over medication and consumable costs,insuffi-cient fineness in DRG grouping,and the inability of payment standards for medium-and low-weighted DRG groups to cover ac-tual resource consumption.It is recommended to refine DRG grouping,establish a differentiated case review trigger and appeal mechanism,and strengthen the clinical supervision of high-value consumables,so as to promote the deep integration of the sepa-rately discussed case policy with DRG payment reform,and improve the efficiency of medical insurance fund utilization and the ca-pacity of medical service delivery.