基于DRGs的公立医院绩效评价研究(1)
摘要：目的 以住院患者的就诊数据为基础，对我院实施DRGs改革的结果进行预判，探索DRGs在医院绩效改革中的应用。方法 从我院的HIS系统中抽取2018年全年的住院患者的信息，根据DRG对病案信息的要求，对提取信息进行清洗和筛选。采用DRG《2016版CN-DRGs分组方案》对患者信息进行分组，采用总权重指数、病例组合指数CMI等指标评价医院各科室的服务能力及服务效率。建立绩效考核的模型，对我院各科室的医疗服务进行评价。结果 我院各科室出院患者覆盖了746个《2016版CN-DRGs分组方案》中的疾病组，覆盖程度高;医疗服务的总权重值为41340.6563，CMI值为0.81893，费用消耗指数为1.11064，时间消耗指数为0.99385。结论 我院信息化建设程度可以适应DRGs改革的要求，住院患者保持较高的入组率。DRGs可以客观评价我院的医疗服务能力、医疗服务效率等，基于DRG的绩效评价可以真实反映我院各科室的实际情况。
關键词：DRGs改革;绩效评价;公立医院
中图分类号：R82 文献标识码：B DOI：10.3969/j.issn.1006-1959.2020.19.002
文章编号：1006-1959(2020)19-0005-04
Abstract：Objective Based on the medical data of inpatients， predict the results of the DRGs reform implemented in our hospital， and explore the application of DRGs in the hospital performance reform.Methods The information of hospitalized patients throughout 2018 was extracted from the HIS system of our hospital， and the extracted information was cleaned and screened according to the requirements of DRG for medical record information. The DRG "2016 CN-DRGs Grouping Plan" was used to group patient information， and indicators such as the total weight index and the case mix index CMI were used to evaluate the service capabilities and service efficiency of each department in the hospital. Establishing a performance appraisal model to evaluate the medical services of various departments in our hospital.Results Discharged patients from various departments in our hospital covered 746 disease groups in the "2016 CN-DRGs Grouping Plan"， with a high degree of coverage; the total weight value of medical services was 41340.6563， the CMI value was 0.81893， and the cost consumption index was 1.11064. The consumption index was 0.99385. Conclusion The degree of informatization construction in our hospital could meet the requirements of DRGs reform， and inpatients maintain a high enrollment rate. DRGs could objectively evaluate the medical service capacity and efficiency of our hospital， and performance evaluation based on DRG could truly reflect the actual situation of our hospital's departments.
Key words：DRGs reform;Performance evaluation;Public hospitals
疾病诊断相分组(DRGs)是根据国际疾病分类(ICD-10)，以病例诊断或操作为主要依据，进一步考虑病例个体特征，如年龄、性别、临床诊断、合并症与并发症、手术、操作、住院天数等因素进行分类的病例组合方式 [1]。DRGs以其高度的科学性和实用性在医疗卫生领域取的多个方面进行了广泛应用，并取得明显的成效[2]，同时也被认为是一个真正以患者为中心、精细化管理的工具。将DRGs应用于公立医院的绩效管理中，才能实现从医院整体战略目标出发，制定合理有效的绩效分配方案[3]。目前，我国很多医疗机构开始对对DRGs进行了深入的探索和研究，部分机构已经将其应用到实际的管理实践中。面对改革的挑战，我院从实际情况出发开始对DRGs进行探索，总结DRG改革的短板，制定医保支付方式改革的实施方案和具体路径，并试图通过DRG来提高我院绩效考核的科学性，现分析如下。, http://www.100md.com(杨柳 问肃生 汪渠)
關键词：DRGs改革;绩效评价;公立医院
中图分类号：R82 文献标识码：B DOI：10.3969/j.issn.1006-1959.2020.19.002
文章编号：1006-1959(2020)19-0005-04
Abstract：Objective Based on the medical data of inpatients， predict the results of the DRGs reform implemented in our hospital， and explore the application of DRGs in the hospital performance reform.Methods The information of hospitalized patients throughout 2018 was extracted from the HIS system of our hospital， and the extracted information was cleaned and screened according to the requirements of DRG for medical record information. The DRG "2016 CN-DRGs Grouping Plan" was used to group patient information， and indicators such as the total weight index and the case mix index CMI were used to evaluate the service capabilities and service efficiency of each department in the hospital. Establishing a performance appraisal model to evaluate the medical services of various departments in our hospital.Results Discharged patients from various departments in our hospital covered 746 disease groups in the "2016 CN-DRGs Grouping Plan"， with a high degree of coverage; the total weight value of medical services was 41340.6563， the CMI value was 0.81893， and the cost consumption index was 1.11064. The consumption index was 0.99385. Conclusion The degree of informatization construction in our hospital could meet the requirements of DRGs reform， and inpatients maintain a high enrollment rate. DRGs could objectively evaluate the medical service capacity and efficiency of our hospital， and performance evaluation based on DRG could truly reflect the actual situation of our hospital's departments.
Key words：DRGs reform;Performance evaluation;Public hospitals
疾病诊断相分组(DRGs)是根据国际疾病分类(ICD-10)，以病例诊断或操作为主要依据，进一步考虑病例个体特征，如年龄、性别、临床诊断、合并症与并发症、手术、操作、住院天数等因素进行分类的病例组合方式 [1]。DRGs以其高度的科学性和实用性在医疗卫生领域取的多个方面进行了广泛应用，并取得明显的成效[2]，同时也被认为是一个真正以患者为中心、精细化管理的工具。将DRGs应用于公立医院的绩效管理中，才能实现从医院整体战略目标出发，制定合理有效的绩效分配方案[3]。目前，我国很多医疗机构开始对对DRGs进行了深入的探索和研究，部分机构已经将其应用到实际的管理实践中。面对改革的挑战，我院从实际情况出发开始对DRGs进行探索，总结DRG改革的短板，制定医保支付方式改革的实施方案和具体路径，并试图通过DRG来提高我院绩效考核的科学性，现分析如下。, http://www.100md.com(杨柳 问肃生 汪渠)