DRG支付制度下的临床路径实施效果评价研究--基于间断时间序列模型  

Study on the Evaluation of the Implementation Effect of Clinical Pathways under the DRG Payment System-Based on Interrupted Time Series Model

作　　者：谷成胜 石平[1] 何明方[1] 康周 马崇淇 肖健[1] 

机构地区：[1]广元市中心医院病案统计科,广元628000

出　　处：《中国医疗保险》2022年第5期11-16,共6页China Health Insurance

基　　金：四川省卫生信息学会科研课题立项课题“DRG支付制度下的临床路径实施效果评价研究——基于间断时间序列模型”(2021014)。

摘　　要：目的:评估临床路径对医院运营及DRG指标的影响程度,为医疗机构主动适应医保支付方式改革提供借鉴。方法:以四川省某三甲医院2019年1月-2021年7月住院患者为研究对象,依托临床路径管理前后的医院运营及DRG评价指标体系数据,利用间断时间序列模型评估干预前后的政策影响及趋势变化。结果:干预后CMI值和总权重每月分别增加0.001(P=0.143)和31.197(P=0.669),时间消耗指数和费用消耗指数每月分别下降0.004(P=0.182)和0.006(P=0.005),标准化死亡率每月下降0.068(P=0.260)。结论:临床路径对效率指标影响最大,产能指标和安全指标变化不明显。Objective:The paper is to evaluate the impact of clinical pathways on DRG indicators,and provide reference for medical institutions to actively adapt to the reform of medical insurance payment methods.Methods:Based on the data of the DRG evaluation index system before and after clinical pathway management,the patients in a tertiary hospital in Sichuan Province from January 2019 to July 2021 are used as the research object,and the interrupted time series model is applied to evaluate the policy impact and trend changes before and after the intervention.Results:After the intervention,the CMI value and total weight increased by 0.001 and 31.197 respectively,and the time consumption index and cost consumption index decreased by 0.004 and 0.006 each month.The standardized mortality rate decreased by 0.068 per month.Conclusion:The clinical pathway has the greatest impact on effi ciency indicators,and changes in productivity indicators and safety indicators are not obvious.

关 键 词：临床路径 疾病诊断相关分组 间断时间序列模型 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]