中国临床药学杂志

目的 评价在疾病诊断分组（DRG）支付背景下多模态管理对肠外营养（PN）合理用药的管控效果。方法 2023年7月1日，医院多部门联动，以DRG病组超支病例用药分析为切入点，实施多模式、多系统、动态跟踪的多模态管理方式，对使用PN治疗的患者进行综合管理，具体措施包括分析DRG超支病例的药物利用数据、采用PN药物计算机处方订单输入（CPOE）系统对不合理用药问题进行干预和建立PN药物动态点评和反馈机制。收集2022年7月1日至2024年6月30日使用PN治疗的胃肠道大手术病组（GB病组）病例共217例，其中干预前（2022年7月1日至2023年6月30日）130例，干预后（2023年7月1日至2024年6月30日）87例。对干预前后PN药物使用的合理性和GB病组的药物相关经济学指标进行评价。结果 多模态管理干预后，PN静脉输液率从3.98%下降到3.00%;PN医嘱的整体不合理率和重点监控药物复方氨基酸注射液（18AA-IX）的医嘱不合理率较干预前均显著下降（P<0.01）;GB病组医疗总费用、药占比和西药费用均显著下降（P<0.05）。结论 通过多模态管理，GB病组的PN药物合理用药水平显著提高，医疗费用结构得到了优化。

AIM To assess the impact of multimodal management on rational use of parenteral nutrition(PN) underthe diagnosis related groups(DRGs) payment system. METHODS A hospital-wide multidisciplinary cooperation, centeredaround the analysis of medication use in overspent cases of DRG disease groups, was carried out for patients undergoinggastrointestinal major surgery who received PN therapy. On August 1, 2023, the cross-departmental quality-enhancingproject was initiated. It adopted a comprehensive management model featuring multimodal control systems and real-timemonitoring mechanisms for PN administration. The intervention plan consisted of regulating the drug utilization data ofoverspent cases in the gastrointestinal major surgery group, creating an intelligent computerized physician order entry(CPOE) system for PN to detect and correct irrational prescriptions, and setting up a dynamic medication assessment andfeedback mechanism to continuously optimize the system. A total of 217 patients undergoing gastrointestinal major surgery(GB group) and receiving PN therapy from July 1, 2022, to June 30, 2024, were gathered. Among them, 130 patients werein the pre-intervention period(from July 1, 2022, to June 30, 2023), and 87 patients were in the post-intervention period(from July 1, 2023, to June 30, 2024). Comparative assessments of PN utilization appropriateness and pharmacoeconomicperformance metrics within the GB group were systematically conducted during pre-and post-intervention phases.RESULTS Post-intervention, the utilization rate of PN intravenous infusions across the hospital was reduced from 3.09%to 3.00%, irrational PN rate(22.1% vs 5.5%, P < 0.01) and irrationality monitored compound amino acid injection(18AA-IX)rate(64.0% vs 3.4%, P < 0.01) were decreased. GB group's total medical expenditure(P < 0.05), drug cost ratio(P < 0.01),and drug expenses(P < 0.01) were significantly declined. CONCLUSION Multimodal management significantly enhancedhospital-wide rational use of PN and improved pharmaceutical expenditure patterns in targeted clinical groups.