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OBJECTIVE To analyze the grouping effect and composition of hospitalization costs for cases of patients with malignant proliferative disease under the diagnosis-related group （DRG） payment system， as well as any changes， in order to provide a basis for medical institutions to improve DRG payment-related measures， control drug costs， and for relevant departments to make decisions. METHODS The data of patients with malignant proliferative disease cases were collected from a “Third Grade Class A” hospital in 2021 and 2022， and the variation coefficient （CV） was used to evaluate the grouping of DRG. The structural variation degree and the new grey correlation analysis were used to study the structural variation of hospitalization cost and the correlation degree between the hospitalization cost and the cost of other items. RESULTS The overall reduction in variance （RIV） for the DRG group of patients with malignant proliferative disease was 79.36%； the CV of other groups were all lower than one except that the RW21 group was 1.09. Compared with 2021， the hospitalization cost for patients with malignant proliferative disease in 2022 decreased by 17.80%， and the decreases in management fees and drug costs were 32.15% and 21.30%， respectively， while the per capita medical expenses increased by 17.26%. The new grey correlation degree of drug cost decreased， but that of medical expenses increased. CONCLUSIONS Under the DRG payment system， hospitalization costs for patients with malignant proliferative disease in the sample hospital decrease， but the grouping efficiency of RW21 and other disease groups needs improvement， and the cost structure needs optimization.
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OBJECTIVE To explor e the effect of clinical pharmacists participatin g in fine management of pharmaceutical affairs among the inpatients in the department of gastroenterology based on diagnosis related groups （DRG）data. METHODS The discharged patients in the gastroenterology department of our hospital were selected as the research objects to compare the changes of DRG indicators and hospitalization related indicators before （from April to December 2019）and after （from April to December 2020 and from April to December 2021） pharmacists participating in fine management of pharmaceutical affairs in the gastroenterology department. The key DRG with the highest number of enrolled cases and DRG cases of the total cost overrun were analyzed to explore the deviation of various costs. The rationality of drug use was evaluated for the cases in each DRG that exceeded the benchmark hospital payment standard by three times ，with the help of prescription doctor ’s advice review. RESULTS In the first year of intervention ，the case combination index value of gastroenterology department was increased ，meanwhile，the cost consumption index ，time consumption index and average hospital stay were decreased significantly （P＜0.01）. In the second year of intervention ，total weight of the cases in gastroenterology department was increased ，while cost consumption index ，time consumption index ，hospitalization cost per time ，drug cost per time and average hospital stay were all decreased significantly ， compared with before intervention （P＜0.01）. Among the top five DRG ，the drug cost per time in the GZ 15，GZ13 and GJ 15 were all decreased significantly in the first year of intervention ；hospitalization cost per time and drug cost per time in the GZ 15，GZ13， GJ15 and GJ 13 were all decreased significantly in the second year of intervention （P＜0.01）；after the intervention of clinical pharmacists in DRG over-expenditure cases ，the over-expenditure rate decreased significantly （P＜0.001）. CONCLUSIONS The fine management of pharmaceutical affairs in our hospital has achieved certain results and promotes the rationality of clinical drug use，and provides a new entry point for the cost control and utilization of medical institutions under the background of 〔2020〕68号） DRG.
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Objective To evaluate curative effect and related prognosis factors of synchronous colorectal cancer with liver metastasis.Methods The clinicopathological and follow-up data of 47 patients undergoing surgical treatment with synchronous colorectal cancer with liver metastasis at Shanghai Jiaotong University Affiliated Sixth People's Hospital and Tongji University Affiliated Yangpu Hospital from Jun 2013 to Jan 2018 were retrospectively analyzed.Results All 47 patients were followed up and themedian followup time was 38 months (2-65 months),after simultaneous colorectal and hepatic neoplasm radical surgery,added in 41 patients by postoperative chemotherapy.There was no perioperative mortality and the postoperative complication rate was 34％.The 1-,3-,and 5-year overall-survival rates were 87％,53％,and 15％,respectively.The disease-free survival rates were 81％,43％,and 9％,respectively.Multivariate results showed tumor differentiation,serum CEA level and adjuvant chemotherapy are independent prognostic factors for patients with synchronous colorectal cancer liver metastasis (P ＜ 0.05).Conclusions Colorectal cancer with synchronous liver metastasis treated by simultaneous resection of colorectal cancer and liver metastases are the widerly adopted treatments.Long-term survival is closely related to the degree of primary neoplasm differentiation,serum CEA level at diagnosis,and postoperative adjuvant chemotherapy.