评估DIP背景下感染控制强化措施对医院感染发病率的影响——基于中断时间序列分析
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R181.3+2

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河北省卫生健康委青年科级课题(20242371)


Impact of intensified infection control measures on the incidence of healthcare-associated infection under the background of diagnosis-intervention packet payment: an interrupted time series analysis
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    摘要:

    目的 评估按病种分值付费(DIP)改革背景下感染控制强化措施对医院感染发病率的影响,为医保支付改革下的医院感染管理提供决策依据。方法 采用中断时间序列研究设计,收集某三级甲等医院2021年10月—2024年9月医院感染监测数据,运用分段线性回归分析医院感染发病率的变化趋势,并通过标准化感染比(SIR)评估干预效果。结果 2021年10月—2022年9月医院感染发病率为2.17%(95%CI:2.08%~2.26%),干预后降至1.87%(95%CI:1.82%~1.92%)。分段线性回归分析显示,干预实施后医院感染发病率即刻下降0.324% (95%CI: -0.481%~-0.167%,P<0.001),且干预后趋势相对于干预前发生显著改变(95%CI: -0.033%~-0.009%,P=0.001)。SIR分析显示,整个干预期间实际发病率相当于干预期发病率的74.56%,从干预初期的88.39%~93.81%逐步稳定至研究末期的67.03%~71.22%,干预效果持续。结论 DIP改革背景下的感染控制强化措施显著降低医院感染发病率并提高感染控制管理稳定性,为探索医保支付与医院感染管理质量协同改进提供了新思路。

    Abstract:

    Objective To evaluate the impact of intensified infection control measures on the incidence of healthcare-associated infection (HAI) under the background of the reform of diagnosis-intervention packet (DIP) payment, and provide decision-making basis for HAI management under the reform of medical insurance payment. Methods The interrupted time series research design was used to collect the monitoring data of HAI in a tertiary first-class hospital from October 2021 to September 2024. The changing trend of HAI incidence was analyzed by piecewise li-near regression, and the intervention effect was evaluated by standardized infection ratio (SIR). Results From October 2021 to September 2022, the incidence of HAI was 2.17% (95%CI: 2.08%-2.26%), which dropped to 1.87% (95%CI: 1.82%-1.92%) after the intervention. Piecewise linear regression analysis showed that the incidence of HAI decreased by 0.324% immediately after the intervention (95%CI: -0.481%- -0.167%, P<0.001), and the trend after the intervention changed significantly compared with that before the intervention (95%CI: -0.033%- -0.009%, P=0.001). SIR analysis showed that the actual incidence during the entire intervention period was equivalent to 74.56% of the incidence in intervention period, gradually stabilized from 88.39%-93.81% at the beginning of the intervention to 67.03%-71.22% at the end of the study, and the intervention effect was sustained. Conclusion Intensified infection control measures under the background of the reform of DIP significantly reduce the incidence of HAI and improve the stability of infection control management, which provide new insights into the synergistic improvement of medical insurance payment and HAI management quality.

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郭栩雯,贾蓓,王欣然,等.评估DIP背景下感染控制强化措施对医院感染发病率的影响——基于中断时间序列分析[J]. 中国感染控制杂志,2025,24(8):1083-1088. DOI:10.12138/j. issn.1671-9638.20252214.
GUO Xuwen, JIA Bei, WANG Xinran, et al. Impact of intensified infection control measures on the incidence of healthcare-associated infection under the background of diagnosis-intervention packet payment: an interrupted time series analysis[J]. Chin J Infect Control, 2025,24(8):1083-1088. DOI:10.12138/j. issn.1671-9638.20252214.

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  • 收稿日期:2025-03-06
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  • 在线发布日期: 2025-08-19
  • 出版日期: 2025-08-28