PDF下载

[1]薛允莲梁会营李丹刘贵浩张冠荣杨小红.冠脉支架集中带量采购对患者住院负担及医疗安全性的影响研究[J].中国卫生质量管理,2025,32(12):27-32.[doi:10.13912/j.cnki.chqm.2025.32.12.06]
　XUE Yunlian,LIANG Huiying,LI Dan.Research on the Impact of Centralized Volume-Based Procurement of Coronary Stents on Patients’ Hospitalization Burden and Medical Safety[J].Chinese Health Quality Management,2025,32(12):27-32.[doi:10.13912/j.cnki.chqm.2025.32.12.06]

点击复制

冠脉支架集中带量采购对患者住院负担及医疗安全性的影响研究

《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R] 卷: 32 期数: 2025年12期页码: 27-32 栏目: 医疗质量出版日期: 2025-12-15

Title:: Research on the Impact of Centralized Volume-Based Procurement of Coronary Stents on Patients’ Hospitalization Burden and Medical Safety

作者:: 薛允莲梁会营李丹刘贵浩张冠荣杨小红; 南方医科大学附属广东省人民医院（广东省医学科学院）

Author(s):: XUE Yunlian; LIANG Huiying; LI Dan; Guangdong Provincial People’s Hospital,Southern Medical University(Guangdong Academy of Medical Sciences)

关键词:: 高值医用耗材; 集中带量采购; 住院负担; 医疗安全; 中断时间序列分析; 冠脉支架

Keywords:: High-Value Medical Consumables; Centralized Volume-Based Procurement; Hospitalization Burden; Medical Safety; Interrupted Time Series; Coronary Stents

分类号:: R197.323；R541.4

DOI:: 10.13912/j.cnki.chqm.2025.32.12.06

文献标志码:: A

摘要:: 目的评价冠脉支架集中带量采购（以下简称“集采”）政策对冠心病介入治疗（PCI）患者住院负担及医疗安全性的影响。方法收集2013—2024年住院接受PCI手术患者的临床资料及医疗费用数据，采用中断时间序列分析评估2021年国家集采政策干预效应，通过线性回归分析指标年度变化趋势，并运用秩和检验、卡方检验对比集采组与非集采组的住院负担及医疗安全性指标的差异。结果政策实施后，患者住院负担显著下降：人均支架费用由集采前27 696.27元降至1 575.74元（降幅94.31%），人均耗材总费用降低54.77%，人均住院费用下降39.09%，耗占比缩减18.21%。人均球囊数和人均导管导丝数均出现一定程度的增长趋势。与非集采组相比，集采组住院天数缩短0.34 d，支架费用节省18 812元，耗材费用节省24 067.5元，住院费用降低24 799.2元，并发症发生率下降0.93%，非预期再住院率下降0.63%，差异有统计学意义（P<0.05）。结论冠脉支架集采政策有效降低了支架价格及患者住院费用负担，且未对医疗安全产生负面影响。但集采后其他非集采耗材费用相对上涨，未来政策制订需关注PCI耗材的整体性，以实现全面费用控制和价值医疗。

Abstract:: ObjectiveTo evaluate the impact of the centralized volume-based procurement (CVBP) policy for coronary stents (hereinafter referred to as the "CVBP policy") on hospitalization burden and medical safety among patients undergoing percutaneous coronary intervention (PCI).MethodsClinical data and healthcare expenditure information were collected from patients who underwent PCI procedures between 2013 and 2024. Interrupted time series analysis was employed to assess the intervention effect of the national CVBP policy implemented in 2021. Linear regression was used to analyze annual trends in key indicators, while the rank-sum test and chi-square test were applied to compare differences in hospitalization burden and medical safety metrics between the CVBP group and the non-CVBP group.ResultsFollowing policy implementation, patients’ hospitalization burden decreased significantly: the average cost per stent dropped from 27 696.27 yuan before CVBP to 1 575.74 yuan (a 94.31% reduction), with total per capita consumable expenses decreasing by 54.77%, the per capita hospitalization cost decreasing by 39.09%, and the proportion of consumable costs by 18.21%. Both the average number of balloons and catheter guidewires per patient showed upward trends. Compared to the non-CVBP group, the CVBP group experienced a 0.34-day reduction in hospital stay, savings of 18 812 yuan in stent costs, 24 067.5 yuan in consumable costs, and 24 799.2 yuan in total hospitalization costs, along with a 0.93% decline in complication rates and a 0.63% decrease in unplanned readmission rates, all statistically significant (P< 0.05).Conclusion The CVBP policy for coronary stents effectively reduced stent prices and patients’ hospitalization expenditure burdens without adversely affecting medical safety. However, costs for other non-CVBP consumables increased relatively post-policy implementation. Future policy formulation should prioritize holistic management of PCI consumables to achieve comprehensive cost control and value-based healthcare.

参考文献/References:

［1］SUN HY, LUAN RL. Current situation, methods, and countermeasures of the quality management of high-value medical consumables in hospitals［J］.Asian J Surg, 2023 46(6):2605-2606.?倓［2］张雪，李玉丹，锁敬芹，等. 医用耗材采购中廉政风险防控的实践与思考［J］. 中国医院管理, 2022,42(9)：88-90.［3］国务院办公厅.关于印发治理高值医用耗材改革方案的通知：国办发〔2019〕37号［EB/OL］.(2019-07-19)［2025-02-20］.https://www.gov.cn/gongbao/content/2019/content_5421542.htm.［4］曹辉.上海公立医院医用高值耗材管理现况探究［J］. 中国医疗设备, 2016,31(6):154-156.［5］董安，钱顺鑫，张之晨. 我院医疗耗材采购流程管理的实践探索［J］. 中国医院管理, 2020, 40(10):90-91.［6］郑洋洋，丁锦希，李佳明. 高值医用耗材带量采购竞价分组方案实证研究［J］. 中国卫生经济, 2021,40(3):13-17.［7］钟磊. 高值医用耗材集中采购对医疗费用的影响研究［J］.呼和浩特:内蒙古财经大学, 2015.［8］王勇平.讨论高值医用耗材集中采购对医疗费用的影响［J］. 经济师, 2021(2):240-241, 244.［9］薛允莲，刘贵浩，耿庆山. 剖宫产药占比的影响因素及中断时间序列分析［J］. 中国病案, 2018,19(9):55-57. ［10］薛允莲. 临床路径管理前后全髋关节置换术患者药占比的中断时间序列分析［J］. 中国卫生统计, 2018,35(3): 413-414,419.［11］谢金平，王斌，陈缪丰，等. 常州市第二批国家药品集中采购政策实施效果研究——基于双组间断时间序列分析［J］. 中国卫生政策研究,2022,15(5): 59-66.［12］洪志斌，李跃平，庄云龙，等. 医用耗材集采政策实施效果评估——以厦门市某三级专科医院为例［J］. 中国医疗保险, 2022(10):40-42.［13］李亚静，王彦泽，张静，等.医用耗材带量采购落地实施存在问题及对策研究［J］. 经济论坛, 2022(4):147-152.［14］钟晨. 降价不降质已有多名患者享实惠［N］.东莞日报, 2021-01-14 (A04).［15］钟磊，张杰，刘宇赤. 我国高值医用耗材集中采购现状及思考［J］. 中国医疗设备, 2018, 33(4):162-166.［16］刘月辉，姚远. 某三甲医院31天内非计划重返住院事件标准化信息监测与管理［J］. 中国卫生质量管理, 2016, 23(1):8-11.［17］高磊. 老年冠心病患者非心脏手术麻醉管理方法对术中、术后并发症的影响［J］. 河北医药, 2018(23):3554-3557,3561.

相似文献/References:

[1]邱英鹏赵翔肖月赵羽西.高值医用耗材定义与治理内涵研究[J].中国卫生质量管理,2021,28(05):1.[doi:10.13912/j.cnki.chqm.2021.28.5.01 ]
　QIU Yingpeng,ZHAO Xiang,XIAO Yue.The Definition and Governance Connotation of High Value Medical Consumables[J].Chinese Health Quality Management,2021,28(12):1.[doi:10.13912/j.cnki.chqm.2021.28.5.01 ]
[2]邱英鹏李理然赵羽西肖月.人工晶体卫生技术评估方法学分析及启示[J].中国卫生质量管理,2021,28(05):4.[doi:10.13912/j.cnki.chqm.2021.28.5.02 ]
　QIU Yingpeng,LI Liran,ZHAO Yuxi.Methodological Analysis and Implications of Health Technology Assessment of Intraocular Lens[J].Chinese Health Quality Management,2021,28(12):4.[doi:10.13912/j.cnki.chqm.2021.28.5.02 ]
[3]赵羽西邱英鹏肖月.英国高值医用耗材准入及招采管理经验分享：以英格兰为例[J].中国卫生质量管理,2021,28(05):8.[doi:10.13912/j.cnki.chqm.2021.28.5.03 ]
　ZHAO Yuxi,QIU Yingpeng,XIAO Yue.Access and Procurement Management of High Value Medical Consumables in the UK: A Case Study of England[J].Chinese Health Quality Management,2021,28(12):8.[doi:10.13912/j.cnki.chqm.2021.28.5.03 ]
[4]邱英鹏赵羽西赵翔肖月.澳大利亚假体类高值医用耗材医保准入管理经验及启示[J].中国卫生质量管理,2021,28(05):12.[doi:10.13912/j.cnki.chqm.2021.28.5.04 ]
　QIU Yingpeng,ZHAO Yuxi,ZHAO Xiang.Experience in Medical Insurance Access Management of Prosthetic High Value Medical Consumables in Australia and Its Implications[J].Chinese Health Quality Management,2021,28(12):12.[doi:10.13912/j.cnki.chqm.2021.28.5.04 ]
[5]孙辉金春林刘昕王昊德符雨嫣王海银.高值医用耗材价值评估框架研究[J].中国卫生质量管理,2022,29(06):9.[doi:10.13912/j.cnki.chqm.2022.29.6.03 ]
　SUN Hui,JIN Chunlin,LIU Xin.Value Evaluation Framework of High-Value Medical Consumables[J].Chinese Health Quality Management,2022,29(12):9.[doi:10.13912/j.cnki.chqm.2022.29.6.03 ]
[6]王悦刘莉孙驰蒋筠宋辉郑晨陈勇张云峰.提高高值医用耗材管理信息追溯覆盖率[J].中国卫生质量管理,2023,30(04):82.[doi:10.13912/j.cnki.chqm.2023.30.4.20 ]
　WANG Yue,LIU Li,SUN Chi.Improving the Management Information Traceability Coverage Rate of High Value Medical Consumables[J].Chinese Health Quality Management,2023,30(12):82.[doi:10.13912/j.cnki.chqm.2023.30.4.20 ]
[7]王家玉肖磊胡亚澜陈琳.带量采购药品配送企业评价体系构建与应用[J].中国卫生质量管理,2023,30(07):74.[doi:10.13912/j.cnki.chqm.2023.30.7.16 ]
　WANG Jiayu,XIAO Lei,HU Yalan.Establishment and Practice of Evaluation System of Drug Distribution Enterprises with Quantity Purchase[J].Chinese Health Quality Management,2023,30(12):74.[doi:10.13912/j.cnki.chqm.2023.30.7.16 ]
[8]彭勇华姚卫光.人工晶体集中带量采购政策对老年性白内障手术患者次均住院费用影响分析[J].中国卫生质量管理,2023,30(08):25.[doi:10.13912/j.cnki.chqm.2023.30.8.06 ]
　PENG Yonghua,YAO Weiguang.Analysis of the Impact of Intraocular Lens Centralized Volume-Based Procurement Policy on the Average Hospitalization Cost of Age-Related Cataract Surgery Patients[J].Chinese Health Quality Management,2023,30(12):25.[doi:10.13912/j.cnki.chqm.2023.30.8.06 ]
[9]林海蓓刘昕罗莉郑蕴欣罗力金春林王海银.基于多准则决策分析的公立医院高值医用耗材准入指标及权重研究[J].中国卫生质量管理,2023,30(11):64.[doi:10.13912/j.cnki.chqm.2023.30.11.14 ]
　LIN Haibei,LIU Xin,LUO Li.Access Indicators and Weights of High-Value Medical Consumables in Public Hospitals Based on Multi-Criteria Decision Analysis[J].Chinese Health Quality Management,2023,30(12):64.[doi:10.13912/j.cnki.chqm.2023.30.11.14 ]

更新日期/Last Update: 2025-12-15