中国临床药学杂志

目的 基于真实世界研究，探索疾病诊断相关分组（DRG）中特定病组临床医师用药习惯并制定优化用药方案，以促进医疗服务效率和质量安全的提升。方法 通过DRG运营分析系统调取数据，筛选出超出支付标准比例较高的病组脑缺血性疾病伴一般并发症与伴随病（BR23）作为研究病组。运用社会网络分析软件Ucinet对该病组2021年6至12月神经内科380例出院病例医嘱进行回顾性分析，提取用药子群，借鉴客观评价法（SOJA）从药物合理性、药物经济学和政策倾斜3个维度制定药物遴选与评价标准，并基于该标准进行医嘱子群优化分析，最终得出优化用药方案。最后在2022年1至3月新入院的185例患者中验证该优化用药方案的有效性及安全性，并与对照组的85例患者进行比较。结果 该研究应用SOJA法制定了药物遴选与评价标准，运用Ucinet分析了BR23病组患者的用药子群并进行了优化，最终获得了涉及5大系统、内含29种药品的优化用药方案。将该方案应用于2022年1月至3月新入院的185例患者中，发现与对照组相比较，其住院费用、药品费用、西药费用和自费费用分别减少2859.2、1671.8、1736.9、494.8元，住院天数缩短0.8d，差异均有统计学意义（P <0.05）;2组患者的出院转归情况均较好。结论 在DRG背景下临床药师运用Ucinet及SOJA法建立用药方案优化模式可有效提升医疗服务效益，助力DRG的顺利施行，也可加速促进临床药师药学服务的转型。

AIM To explore the drug therapy regimen of clinicians for specific diagnosis related group(DRG) and develop an optimal medication plan basing on real world research, and to further improve the efficiency, quality and safety of medical services. METHODS The data was collected through the DRG operation analysis system, and the BR23 group(cerebral ischemic disease, accompanied with common comorbidities and concomitant diseases) was selected as the study group due to a high proportion of discharged cases from June to December 2021 exceeding the payment standard.Social network analysis software Ucinet was used to retrospectively analyze all the medical orders of 380 discharged patients in the department of neurology during the period and extract the subgroup network. Drawing on the system of objectified judgement analysis(SOJA), drug selection and evaluation criteria were established including drug rationality,pharmacoeconomics and policy inclination. The subgroup network was optimized based on the above criteria, and an optimal medication plan was obtained. Finally, the efficacy and safety of the optimized medication plan was verified in 185 patients in intervention group newly admitted from January to March 2022, and compared with 85 patients in control group during the same period. RESULTS In this study, SOJA method was used for reference to develop the drug selection and evaluation criteria of our hospital, and Ucinet was used to analyze and optimize the drug subgroups network of BR23 group, and an optimal drug plan involving 29 drugs from 5 systems was obtained finally. Compared with the control group, the hospitalization cost, drug cost, western medicine cost and out-of-pocket amount of patients in the intervention group admitted between January and March 2022 were reduced by 2 859.2 yuan, 1 671.8 yuan, 1 736.9yuan and 494.8 yuan respectively, and the hospitalization days were shortened by 0.8 d(P < 0.05), while there were good outcomes between 2 groups. CONCLUSION In the context of DRG, the model of drug regimen optimization established by clinical pharmacists with the Ucinet and SOJA can effectively improve the benefit of medical services, facilitate the smooth implementation of new policies such as DRG, and accelerate the transformation of pharmaceutical care for clinical pharmacists.