基于间断时间序列分析DRGs背景下药品精细化管控对骨科合理用药的影响

doi:10.5246/jcps.2025.08.058

中国药学(英文版) ›› 2025, Vol. 34 ›› Issue (8): 775-783.DOI: 10.5246/jcps.2025.08.058

基于间断时间序列分析DRGs背景下药品精细化管控对骨科合理用药的影响

胥甜甜¹^,^#, 涂颖秋¹^,^#, 章胜涛², 肖俊², 张斌²^,^*(), 赖福崇²^,^*

^1. 南昌大学第一附属医院药学部, 江西南昌 330000
^2. 南昌大学第一附属医院骨科医院, 江西南昌 330000

收稿日期:2025-04-23 修回日期:2025-05-10 接受日期:2025-05-23 出版日期:2025-08-29 发布日期:2025-08-29
通讯作者: 张斌, 赖福崇

Evaluating the impact of refined drug control on orthopedic medication use in the DRGs system: An interrupted time series analysis

Tiantian Xu¹^,^#, Yingqiu Tu¹^,^#, Shengtao Zhang², Jun Xiao², Bin Zhang²^,^*(), Fuchong Lai²^,^*

¹ Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi, China
² Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi, China

Received:2025-04-23 Revised:2025-05-10 Accepted:2025-05-23 Online:2025-08-29 Published:2025-08-29
Contact: Bin Zhang, Fuchong Lai
About author:
^# Tiantian Xu and Yingqiu Tu contributed equally to this work.
Supported by:
Jiangxi Provincial Hospital Pharmacy Special Research Fund Project (Grant No. 2024-ZXYJ02).

摘要/Abstract

摘要：

探讨DRGs背景下骨科医院开展药品精细化管控, 对骨科药品费用的影响, 为临床合理用药提供药学参考。通过统计骨科医院2021年1–12月(管控前)的不合理医嘱类型, 多维度分析不合理用药原因, 开展精细化管控, 对比2022年1–12月(管控后)均次费用、高药费病组药费、药占比等, 并利用间断时间序列分析法对其进行分析。骨科实行药品精细化管控后, 次均费用、次均药品费、药占比、费用消耗指数、平均住院日、拨付比下降(P < 0.05); 管控第一个月(2022年1月), 均次药费显著下降1272.90元(P < 0.01)、药占比下降0.98%、IC29病组药费下降616.79元(P > 0.05), 不合理医嘱率由2021年的40.48%下降至2022年12月份的3.57%。由此可见, 药品精细化管控有利于提升临床用药的合理性, 降低用药不良反应发生率, 提升患者用药依从性, 具有重要的临床意义。

关键词: 精细化管控, 均次药费, 间断时间序列

Abstract:

In the context of the Diagnosis Related Groups (DRGs) system, the orthopedic hospital implemented refined drug control to provide a pharmacological reference for promoting rational clinical drug use. A statistical analysis was conducted on the hospital’s data from January to December 2021 (prior to the implementation of control), focusing on the types of unreasonable prescriptions. A multi-dimensional analysis was also conducted to identify the underlying causes of inappropriate medication practices. Following this, refined drug control measures were introduced, and data from January to December 2022 (post-control) were compared, examining factors such as the average drug cost, drug expenses for the IC29 diagnosis group, and the drug cost ratio. An interrupted time-series analysis was employed to evaluate the effects of these interventions. The results showed that after the implementation of refined drug control in the orthopedic department, significant reductions were observed in the average cost per patient, average drug cost per patient, drug cost ratio, cost consumption index, average length of hospital stay, and allocation ratio (P < 0.05). In particular, the first month of control (January 2022) saw a marked decrease in average drug costs per patient by 1272.90 yuan (P < 0.01), a reduction in the drug cost ratio by 0.98%, and a decline in drug costs for the IC29 diagnosis group by 616.79 yuan (P > 0.05). Moreover, the rate of unreasonable inappropriate prescribing dropped dramatically from 40.48% in 2021 to 3.57% by December 2022. The refined control of drug use within the orthopedic hospital significantly improved the rationality of clinical prescribing practices, reduced the occurrence of adverse drug reactions, and enhanced patient adherence to prescribed treatments. These findings demonstrated considerable clinical value in promoting efficient and safe drug use.

Key words: Refined control of drugs, Average drug cost, Interrupted time series

Supporting:

胥甜甜, 涂颖秋, 章胜涛, 肖俊, 张斌, 赖福崇. 基于间断时间序列分析DRGs背景下药品精细化管控对骨科合理用药的影响[J]. 中国药学(英文版), 2025, 34(8): 775-783.

Tiantian Xu, Yingqiu Tu, Shengtao Zhang, Jun Xiao, Bin Zhang, Fuchong Lai. Evaluating the impact of refined drug control on orthopedic medication use in the DRGs system: An interrupted time series analysis[J]. Journal of Chinese Pharmaceutical Sciences, 2025, 34(8): 775-783.

图/表 6

Figure 1. Plato’s diagram of the causes of high drug costs.

Table 1. Analysis of DRG patient hospitalization costs, 2022 vs. 2021.

Table 2. Impact of refined drug control on each of the observed indicators.

Figure 2. Changes in average drug expenses before and after refined drug control.

Figure 3. Changes in drug cost ratio before and after refined drug control.

Figure 4. Changes in drug expenses in the IC29 group before and after refined drug control.

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基于间断时间序列分析DRGs背景下药品精细化管控对骨科合理用药的影响

Evaluating the impact of refined drug control on orthopedic medication use in the DRGs system: An interrupted time series analysis

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