从DRGs数据测算探析中医院管理问题  

Analysis of Management Problems in Traditional Chinese Hospitals Based on DRGs Data Calculation

作　　者：郭慧君[1] 刘婕[1] 周仪洁[1] 贾春梅 GUO Huijun;LIU Jie;ZHOU Yijie(Xiyuan Hospital,China Academy of Chinese Medicine,Beijing,100091,China)

机构地区：[1]中国中医科学院西苑医院,北京100091

出　　处：《中国卫生质量管理》2020年第2期53-56,共4页Chinese Health Quality Management

摘　　要：随着我国医疗制度改革的进一步深化,以DRG收付费为主体的多种付费制度即将来临。文章参照2018年底北京市2615号文件发布的试行病组价格,对某三甲中医医院2018年出院数据展开DRG付费模拟数据测算。试行病组价格与病例总费用的差额定义为收入增减额,若试行病组价格高于该病历住院总费用,则认为改革后收入增加,反之定义为收入减少。本研究从收入增减额入手,首先测算改革后该院住院总收入的增减趋势,重点分析收入增减额排名前3的病组,通过数据分析、病历查询、病案及医保负责人咨询,发现收入增减病组的特点及原因,提出针对该院医疗管理、绩效考核、病案填写方面的建议,旨在通过精细化管理提高医院资源利用效率,更好地发挥中医药特色。With the further deepening of China’s medical system reform,multiple-payment systems with DRG as the main body are coming.In this paper,the DRG payment simulation data was calculated based on the discharge data of a tertiary Traditional Chinese Medicine(TCM)Hospital in 2018,by referring to the price of the pilot DRGs,attachment of〔2018〕2615 document released by Beijing government.The difference between the price of the pilot disease group and the total cost of cases was defined as the increase or decrease of income.If the price of the pilot disease group was higher than the total cost of hospitalization in the medical record,the income would be considered to increase after the reform,and vice versa.From the income change,this study firstly described the trend of the total income change in the hospital after the reform under static calculation,and emphatically focused on the analysis of the top three disease groups ranking with the income change.Through data analysis,medical records inquiry and consultation with the medical records and medical insurance responsible person,the characteristics and reasons of income increase or decrease disease groups were found.Suggestions on medical management,performance assessment,medical records filling were provided,aiming to improve resource utilization efficiency through the fine management,and to give full play to the characteristics of TCM.

关 键 词：中医医院 DRG收付费 数据模拟测算 医院管理 

分 类 号：R197.323[医药卫生—卫生事业管理] R197.4[医药卫生—公共卫生与预防医学]