Department of Trauma and Emergency Surgery, Linkou Branch of Chang Gung Memorial Hospital, No. 5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan.
Department of General Surgery, Linkou Branch of Chang Gung Memorial Hospital, No. 5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan.
World J Surg. 2021 Apr;45(4):1080-1087. doi: 10.1007/s00268-020-05904-5. Epub 2021 Jan 16.
Laparoscopic cholecystectomy (LC) is a common procedure for cholelithiasis paid by diagnostic-related groups (DRGs) systems. However, acute cholecystitis (AC) patients usually have heterogeneous conditions that compromise the successful implementation of DRGs. We evaluated the quality/efficiency of treating AC patients under the DRG system in Taiwan.
All AC patients who underwent LC between October 2015 and December 2016 were included. Patient demographics, treatment outcomes, and financial results were analyzed. Patients were reimbursed by one of the two DRG schemes based on their comorbidities/complications (CC): DRG-1, LC without CC; and DRG-2, LC with CC. Hospitals were reimbursed the costs incurred if they were below the lower threshold (balanced sector); with the outlier threshold if costs were between the lower and outlier thresholds (profitable sector); and with the outlier threshold plus 80% of the exceeding cost if costs were higher than the outlier threshold (profit-losing sector).
Among 246 patients, 114 were paid by DRG-1, and 132 were by DRG-2. In total, 195 of 246 patients underwent LC within 1 day after admission, and patients with mild AC had shorter hospital stays than those with moderate or severe AC. The complication rate was 7.3% with only one mortality. In total, 92.1% of patients in DRG-1 and 90.9% of patients in DRG-2 were profitable. The average margin per patient was 11,032 TWD for DRG-1 and 24,993 TWD for DRG-2.
DRGs can be well adopted for acute care surgery, and hospitals can still provide satisfactory services without losing profit.
腹腔镜胆囊切除术（LC）是按诊断相关分组（DRGs）系统支付的胆石症常用手术。然而，急性胆囊炎（AC）患者的病情通常各不相同，这会影响 DRGs 的成功实施。我们评估了台湾地区按 DRG 系统治疗 AC 患者的质量/效率。
纳入 2015 年 10 月至 2016 年 12 月期间接受 LC 的所有 AC 患者。分析患者的人口统计学特征、治疗结果和财务结果。根据合并症/并发症（CC），患者按以下两种 DRG 方案之一获得补偿：DRG-1，无 CC 的 LC；DRG-2，有 CC 的 LC。如果医院的费用低于下限阈值（平衡部门），则按实际费用报销；如果费用在下限阈值和异常值阈值之间（盈利部门），则按异常值阈值加上 80%的超额费用报销；如果费用高于异常值阈值（亏损部门），则按异常值阈值加 80%的超额费用报销。
在 246 例患者中，114 例患者按 DRG-1 付费，132 例患者按 DRG-2 付费。共有 246 例患者中的 195 例在入院后 1 天内接受了 LC，且轻度 AC 患者的住院时间短于中重度 AC 患者。并发症发生率为 7.3%，仅有 1 例死亡。DRG-1 组中 92.1%的患者和 DRG-2 组中 90.9%的患者盈利。DRG-1 组每位患者的平均利润为 11032 新台币，DRG-2 组为 24993 新台币。
DRGs 可很好地应用于急性外科治疗，医院仍可在不亏损的情况下提供满意的服务。
