Research on the Causes of DRG High-Rate Cases and Their Control Pathways
- VernacularTitle:DRG高倍率病例成因及其管控路径研究
- Author:
Sujing WEI
1
;
Zaixiang TAN
;
Jing YANG
Author Information
1. 徐州医科大学徐州临床学院 江苏 徐州 221006
- Publication Type:Journal Article
- Keywords:
high-rate cases;
DRG;
control pathways
- From:
Chinese Hospital Management
2025;45(2):53-56,73
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the causes of high-rate DRG cases and to propose effective management countermeasures to address the challenges posed by high-rate cases to the economy of hospitals and the quality of medical services.Methods Data of 6 937 high-rate cases and 120 782 normal-rate cases were analyzed using Excel 2021,and the causes of high-rate cases were analyzed in conjunction with the results of medical quality inspections.Results High-rate cases exhibit significantly higher average benchmark points and per capital hospitalization costs compared to normal cases,especially those with benchmark points exceeding 300,where the average cost reaches up to 151 906.70 yuan.The high-rate cases were concentrated in the group of complex diseases such as invasive ventilator support ≥96 hours or ECMO or total artificial heart transplantation.Conclusion The main causes of high-rate cases include complex and severe cases,operational errors of doctors and coders,over-treatment,and the practice of"under-coding with over-charging".To effectively control the number of high-rate cases,improve the quality of medical services,and alleviate the economic pressure on hospitals,the following countermeasures were proposed:improving medical insurance supporting policies,strengthening the training of medical teams,promoting the construction of information technology,formulating clinical pathways,and reinforcing medical supervision.
