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中国诊断相关群体系统与低值冠状动脉复血管化的关联:中断时间序列分析

Kun Zou^1,2,3, Wenting Su⁴, Lingli Zhang^1,2,3,5

¹Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Sichuan, People's Republic of China.

|March 23, 2025

概括

中国的诊断相关组 (C-DRG) 支付系统成功地减少了冠状动脉疾病患者的低价值冠状动脉复血管化. 这一政策也显示出高价值程序的增加,支持其提高护理质量的有效性.

科学领域:

卫生经济学卫生经济学
心血管医学心血管医学
卫生政策卫生政策

背景情况:

冠状动脉疾病 (CHD) 管理涉及复杂的干预措施,包括冠状动脉再血管化.
像中国诊断相关集团 (C-DRG) 这样的支付系统的实施旨在优化医疗保健资源配置并提高服务价值.
评估C-DRG对利用低价值和高价值冠状动脉复血管化的影响对于了解其在心血管疾病护理中的有效性至关重要.

研究的目的:

评估C-DRG支付系统对CHD住院患者的低价值冠状动脉复血管服务的影响.
确定C-DRG政策是否影响使用高价值的冠状动脉再血管服务.
为决策者提供关于C-DRG对CHD干预的质量和效率的影响的证据.

主要方法:

这是一项回顾性观察性研究,利用了来自中国三明市22家公立医院的医疗保险索赔数据.
包括2017年1月至2020年12月的所有CHD住院患者,并于2018年1月1日实施C-DRG.
间断时间序列分析,比较C-DRG实施前后的低值 (没有急性疾病的缺血性心脏病) 和高值 (急性冠状动脉综合征) 冠状动脉再血管化的比率.

主要成果:

C-DRG政策与低价值冠状动脉复血管化率的立即统计显著下降 -9.78%有关.
在C-DRG实施后,观察到低价值冠状动脉复血管化的持续季度下降率为-0.59%.
在C-DRG实施后,高价值冠状动脉复血管化的季度率增加了1.27%,这表明可能会转向更有利的程序.

结论:

该C-DRG支付系统在短期内取得了成功,减少了CHD患者中低价值冠状动脉复血管化的使用.
没有证据表明C-DRG政策降低了提供高价值冠状动脉复血管服务的情况.
这些发现支持使用C-DRG政策来减少低价值护理,并可能增强中国和类似医疗保健系统的高价值护理.

关键词:

冠心病是一种冠心病.卫生经济学卫生经济学卫生政策卫生政策医疗保健的质量在医疗保健的质量.

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