基于DRG的冠心病中成药临床用药路径构建与应用成效分析OA

OBJECTIVE:To explore the effects of clinical pathway for Chinese patent medicines in coronary heart disease(CHD)based on diagnosis-related groups(DRG)on clinical efficacy,safety,and cost-effectiveness.METHODS:An evidence-based approach was used to develop a pathway integrating syndrome differentiation.CHD patients admitted to the Department of Cardiology of the hospital from January to October 2024 were selected and randomly assigned into observation group and control group,with 140 cases in each group.Finally,136 cases in the observation group and 134 cases in the control group were included for analysis.The observation group followed the clinical pathway for Chinese patent medicines formulated based on DRGs and TCM syndrome differentiation,while the control group received conventional treatment.Efficacy indexes(mortality,the incidence of cardiovascular events),safety indexes(inappropriate medication orders,adverse drug events),and economic indexes(medical insurance balance,length of hospitalization stay,cost composition)were compared between 2 groups.RESULTS:There were no statistically significant difference in mortality or the incidence of cardiovascular events between the two groups(P>0.05).The incidence of irrational medical orders(0.74%vs.5.22%,P=0.040)and the length of hospital stay[6.00(4.00,7.00)d vs.6.00(5.00,8.00)d]in the observation group were significantly lower than those in the control group(P<0.05).The total drug costs in the observation group[1 957.38(1 199.51,2 606.58)yuan vs.1 909.47(1 386.23,3 100.53)yuan]were lower than those in the control group(P=0.05).The medical insurance surplus increased in both groups(239 159.16 yuan vs.187 508.26 yuan),with no statistically significant difference(U=8 416.5,Z=-1.084,P=0.279).However,there was a trend toward a greater surplus in the observation group:the mean surplus was 359.21 yuan higher and the median surplus was 533.34 yuan higher than those in the control group.There was no statistically significant difference in total hospitalization cost,total cost of Chinese patent medicines and the cost of centralized procurement drugs between the two groups(P>0.05).CONCLUSIONS:The DRG-based clinical pathway for Chinese patent medicines in CHD improves medication rationality,reduces medical costs,achieves a positive medical insurance balance,and has good cost-effectiveness on the premise of not affecting clinical safety,which is suitable for promotion and application in clinical management.