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DRG背景下临床药师参与消化内科药事精细化管理的实践
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| 篇名： | DRG背景下临床药师参与消化内科药事精细化管理的实践 |
| TITLE： | Practice of clinical pharmacists participating in fine management of pharmaceutical affairs in gastroenterology department based on DRG data |
| 摘要： | 目的 探讨临床药师基于疾病诊断相关分组（DRG）参与消化内科住院患者药事精细化管理的成效。方法选取我院消化内科进入DRG病组的出院患者为研究对象，比较临床药师参与消化内科药事精细化管理干预前（2019年4－12月）、干预后（2020年4－12月、2021年4－12月）患者的DRG指标以及住院相关指标的变化情况；对入组例数排名靠前的重点DRG病组和超出支付标准的DRG病例进行重点分析，探究各项费用的偏离情况；借助处方医嘱点评手段，对每个DRG病组中超过标杆医院3倍支付标准的病例开展用药合理性评价。结果在干预第1年，消化内科病例组合指数值升高，费用消耗指数、时间消耗指数、平均住院日均显著降低（P＜0.01）；在干预第2年，消化内科病例总权重升高，费用消耗指数、时间消耗指数、次均住院费用、次均药品费用和平均住院日均较干预前显著降低（P＜0.01）。在入组例数排名前5位的DRG病组中，在干预第1年，GZ15、GZ13和GJ15病组次均药品费用均显著下降；在干预第2年，GZ15、GZ13、GJ15和GJ13病组次均住院费用和次均药品费用均较干预前显著下降（P＜0.01）。临床药师对DRG超支病例进行干预后，超支率显著下降（P＜0.001）。结论DRG背景下，我院药事精细化管理措施取得了一定成效，提高了临床用药的合理性，为医疗机构的费用控制和利用提供了新的切入点。 |
| ABSTRACT： | OBJECTIVE To explor e the effect of clinical pharmacists participatin g in fine management of pharmaceutical affairs among the inpatients in the department of gastroenterology based on diagnosis related groups （DRG）data. METHODS The discharged patients in the gastroenterology department of our hospital were selected as the research objects to compare the changes of DRG indicators and hospitalization related indicators before （from April to December 2019）and after （from April to December 2020 and from April to December 2021） pharmacists participating in fine management of pharmaceutical affairs in the gastroenterology department. The key DRG with the highest number of enrolled cases and DRG cases of the total cost overrun were analyzed to explore the deviation of various costs. The rationality of drug use was evaluated for the cases in each DRG that exceeded the benchmark hospital payment standard by three times ，with the help of prescription doctor ’s advice review. RESULTS In the first year of intervention ，the case combination index value of gastroenterology department was increased ，meanwhile，the cost consumption index ，time consumption index and average hospital stay were decreased significantly （P＜0.01）. In the second year of intervention ，total weight of the cases in gastroenterology department was increased ，while cost consumption index ，time consumption index ，hospitalization cost per time ，drug cost per time and average hospital stay were all decreased significantly ， compared with before intervention （P＜0.01）. Among the top five DRG ，the drug cost per time in the GZ 15，GZ13 and GJ 15 were all decreased significantly in the first year of intervention ；hospitalization cost per time and drug cost per time in the GZ 15，GZ13， GJ15 and GJ 13 were all decreased significantly in the second year of intervention （P＜0.01）；after the intervention of clinical pharmacists in DRG over-expenditure cases ，the over-expenditure rate decreased significantly （P＜0.001）. CONCLUSIONS The fine management of pharmaceutical affairs in our hospital has achieved certain results and promotes the rationality of clinical drug use，and provides a new entry point for the cost control and utilization of medical institutions under the background of 〔2020〕68号） DRG. |
| 期刊： | 2022年第33卷第17期 |
| 作者： | 伍渊麟，陈世耕，鲜秋婉，毕小婷，张攀，刘耀 |
| AUTHORS： | WU Yuanlin ，CHEN Shigeng ，XIAN Qiuwan ，BI Xiaoting ，ZHANG Pan，LIU Yao |
| 关键字： | 疾病诊断相关分组；临床药师；消化内科；药事精细化管理 |
| KEYWORDS： | diagnosis related groups ；clinical pharmacist ； |
| 阅读数： | 471 次 |
| 本月下载数： | 14 次 |
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