按病种付费下某院出院病例构成与难度分析

Objective To explore the disease composition status of discharged patients in a tertiary general hospital under the background of diagnosis related groups(DRG) payment and analyze the level of disease case mix index(CMI) value. Methods Retrospectively, the data of the first page of medical records of 307, 896 discharged patients from January 1, 2019 to December 31, 2022 in the hospital information system were extracted. Based on the International Classification of Diseases-10(ICD-10), the main diagnoses were statistically analyzed. The top 10 systemic diseases of discharged patients were counted, and the total CMI value for the year and the CMI values of the top 10 systemic diseases were calculated. The causes of death for inpatient deaths were analyzed. Results From 2019 to 2022, the composition of the top five diseases in each year was the same and the order was different. Circulatory system disease rose from the fifth to the second, respiratory system disease fell from the first to the third, and health and medical contact factors rose from the fourth to the first. From 2019 to 2022, the total CMI values of various years were 0.89, 0.82, 0.95 and 1.03 respectively. The total CMI value showed a downward trend in 2020 compared to 2019, but a continuous upward trend from 2020 to 2022. The top three diseases of the CMI value were tumor(1.52), circulatory system disease(1.31), some infectious diseases and parasitic diseases(1.28), which were higher than the average value of the total CMI in the hospital. Pareto chart analysis showed that the top three causes of death in hospitalized patients were circulatory system disease, tumor and respiratory system disease. Tumor caused the highest death rate, while circulatory system disease accounted for the largest proportion of deaths. Conclusion Under the background of DRG payment, medical institutions can rationally allocate the medical resources according to the composition of major diseases, the annual total CMI value and the CMI value changes of the top ten diseases, pay attention to the prevention and treatment of difficult and critical diseases such as circulatory system and tumor, improve the diagnosis and treatment level of key diseases, and improve the operation efficiency under DRG payment.