Research On Comparable Medicine Cost Proportion Of Inpatients Based On DRGs

Purpose:The medicine cost proportion of inpatients in the hospital fees (hereinafter referred to as the "medicine cost proportion") has been used as a visual indicators as well as an important measure in controlling drug expense unreasonable growth, and improving the rational use of drugs to promote hospital management level, which also has got more and more attention by management department as an important management elements. The direct comparison of the medicine cost proportion between hospitals or within hospital units is flawed due to difference in the average severity of illness of patients hospitalized in specific institution as well as due to different structures and missions of hospitals, which usually cause deviation and confused for evaluation and affect the whole system of management.This study aims to explore the case mix method of hospital medical record home page data; To analyze the main factors influencing the objectivity of medicine cost proportion based on DRGs grouping, to determine the weight of inpatients medicine cost proportion, to discuss the feasibility and significance of comparable medicine cost proportion, to introduce a novel method to detect variations in medicine cost proportion within and between hospitals, in order to further control the irrational drug use and objective evaluate the rational drug use level of medical institution as decision-making reference. Methods:To collect hospitalized patients medical record home page data of a3A hospital in the past2009-2013, to set up a corresponding EXCEL database, to select effective medical records; to give the descriptive analysis of data with SPSS software; According to the requirements of the main diagnostic code in Dalian, the experience of Beijing BJ-DRGs grouping method and the international classification of diseases coding the tenth edition (ICD-10), inpatients medical records data of the sample hospitals in2009-2013is determined to the type of main disease (major diagnostic category, the MDC) grouping results according to the characteristics of the sample cases and the scope; To points into the corresponding main diagnostic category according to the primary diagnosis cases.Then according to the set of case mix and the decision tree method, case mix is made with SAS software program; We mainly choose the diagnostic codes, procedures and complications, hospital number, variable factors such as age, gender, as a group node ariable. We use drug expenses as grouping axis, with DRGs grouping method as data mining methods, and chi-squared Automatic Interaction Detector, to analyze the factors influencing patients drug expenses. According to the given response variables and the interpretation of the filtered to the optimal segmentation, samples shall be carried out in accordance with the significance of chi-square automatic judgment grouping multiple contingency table; Hospitalization expenses, drug expenses, the weights of each DRGs and the hospital are calculated respectively.Results:1. With DRGs, we know well about the detail information of inpatients cost, medicine cost and medicine cost proportion of different mixs, as well as their internal connection.2. After DRGs, the difference of medicine cost proportion within each mix and between mixs are both significant, which proved the necessity and the reason of DRGs.3. The influencing factors for medicine cost proportion include operation process, complication, age, etc. And the cost of one-time high-value consumables and instruments during operation greatly influence the objectivity of medicine cost proportion, that is why we introduce the concept of comparable medicine cost proportion.Conclusion:1. The author puts forward the concept of comparable medicine cost proportion within and between medical institutions, provides theoretical support for the future work. Direct comparison of the inpatients medicine cost proportion between and within hospitals can be done with DRGs, which also can be used to measure rational drug use level of medical institutions of a standard, and for administrative department to evaluate, compare and assess the rational drug use of medical institutions.2. Looking for the way of comparison of medicine cost proportion within and between different medical institutions. Grouping of inpatients with DRGs method is scientific, medicine cost proportion can be compared of the same group. With the weights of different groups’medicine cost proportion, the formula and database can be established, which is comparable between different medical institutions.3. Medicine cost proportion has been greatly influenced by operation cost, large equipment inspection cost and the cost of disposable high-value consumables, which in some diseases has been more than medicine cost proportion, greatly enhance the hospitalization expenses, as a new burden on hospitalized patients.