中国感染控制杂志2026，Vol.25Issue(2)：244-253,10.DOI:10.12138/j.issn.1671-9638.20262616
DRG付费与多学科协作对 ICU 抗菌药物使用强度的影响
Impact of diagnosis-related group and multidisciplinary team management on antimicrobial usage density in intensive care unit:a study on time-series model based on CMI calibration
摘要
Abstract
Objective To investigate the dynamic impact of diagnosis-related group(DRG)payments reform and multidisciplinary team(MDT)management on the antimicrobial usage density(AUD)in intensive care unit(ICU),and construct an interrupted time series prediction model calibrated by the case-mix index(CMI),so as to break through the static limitations of traditional cross-sectional studies.Methods Data from ICU of a tertiary hospital from January 2021 to December 2024 were analyzed by the double interrupted time series(DITS)approach com-bined with an autoregressive integrated moving average(ARIMA)model.The implementation of DRG in October 2022 and the implementation of MDT management in August 2023 were identified as the key intervention points.Residual-calibrated sequences were constructed via CMI linear regression to control case complexity confounding,and model performance and predictive capability were assessed.Results The AUD exhibited a downward trend(β1=-1.70)after the implementation of DRG,while the trend reversed to an upward direction(γ1=3.38)after the implementation of MDT management,though with no statistical significance.After adjusting case complexity confounders via the CMI linear regression residual method,MDT management demonstrated a significant positive impact on the trend in antimicrobial usage.The ARIMA constructed based on the calibrated sequence demonstrated robust predictive performance.Conclusion The CMI-calibrated time-series model can effectively control confoun-ding and analyze the dynamic heterogeneity of policy interventions.The"confounding control-dynamic prediction"integrated framework constructed in this study provides a data-driven decision support tool for the refined manage-ment of antimicrobial agents.关键词
DRG付费/抗菌药物使用强度/重症监护病房/双重中断时间序列/预测模型Key words
DRG payment/antimicrobial usage density/intensive care unit/double interrupted time series/predictive model分类
医药卫生引用本文复制引用
朱萍,唐慧,陈蕊欢,张静,殷卫清,潘妮芳..DRG付费与多学科协作对 ICU 抗菌药物使用强度的影响[J].中国感染控制杂志,2026,25(2):244-253,10.基金项目
江苏省医院协会医院药事管理研究专项课题基金(JSYGY-3-2024-YS44) （JSYGY-3-2024-YS44）
江苏省药学会-奥赛康医院药学科研基金(A202431) （A202431）
苏州市科技发展计划(民生科技-医疗卫生应用基础研究)基金(SYWD2024266) （民生科技-医疗卫生应用基础研究）
苏州市医学重点学科(SZXK202528) （SZXK202528）
常熟市软科学研究项目(CR202413) （CR202413）
