基于DRGs数据对某医院骨科医疗控费管理的评价  

Evaluation of Orthopedic Medical Cost Management in a Hospital Based on DRGs Data

作　　者：杨阳[1] 李德昊[1] 王玉锋[1] 王昆[1] Yang Yang;Li Dehao;Wang Yufeng;Wang Kun(Department of Nursing,Chinese PLA General Hospital,Beijing 100853,China;不详)

机构地区：[1]中国人民解放军总医院,北京市100853

出　　处：《中国病案》2022年第12期80-83,共4页Chinese Medical Record

基　　金：国家重点研发计划—数字诊疗装备研发专项课题(2019YFC0119604)。

摘　　要：目的 通过基于DRGs的数据分析,对某院骨科各病区的医疗控费管理进行评价,为医院整体医疗控费管理提供数据支持。方法 调取某三甲医院2020年1月1日-2020年3月31日出院科室为骨科,数据信息完整、准确的534份病例进行DRGs数据分析。通过比较骨科6个病区不同月份DRGs数据所描述的工作量差异,从医疗服务能力、资源使用效率、医疗质量以及费用控制多个维度对各病区医疗控费管理评价进行探讨。结果 此医院骨科共6个病区,DRGs组数涉及病组最广的是一病区,平均为33组;涉及病组最窄的是二病区,平均为11组。疑难危重指数最高的是三病区,CMI值平均为2.34;疑难危重指数最低的是五病区,CMI值平均为1.17。从费用消耗指数分析,费用控制最差的是五病区,费用消耗指数平均为1.93;费用控制最优的是二病区,费用消耗指数平均为0.91。从时间消耗指数来看,6个病区时间消耗指数平均都小于1,时间成本均控制较好。结论 医院管理部门通过DRGs数据监测,可加强对效率较低科室的监督和管理,提高医院整体运行效率。并应当优化医疗管理工作量以及资源消耗测算方法使其匹配DRGs的应用,将实际工作量和资源消耗在绩效考核中得以合理体现。Objectives Based on the diagnosis related grouping data of a hospital, the medical cost control of its orthopedic department was evaluated. Methods To select a Three A and Tertiary Hospital as the sample hospital,534 cases with complete and accurate data information were transferred from the department of orthopedics discharged from January 1st, 2020 to March 31st, 2020 for DRGs data analysis. According to the workload difference of different wards and different time in the orthopedic department of the hospital, the corresponding DRGs scheme is adopted. By comparing the workload differences described by DRGs schemes in different periods in six wards, this paper discusses the evaluation of medical cost control in each ward from the dimensions of medical service capacity, resource utilization efficiency, medical quality and cost control. Results There are six orthopedic wards in this hospital, and the most widely involved DRGs group was orthopedic ward 1(average 33 groups);Orthopedic ward 2 involved the least, average 11 groups. The average CMI value of the third ward of orthopedics was 2.34, and the average CMI value of the fifth ward of orthopedics was 1.17. From the perspective of cost consumption index, among the six wards, the fifth ward of orthopedics has the worst cost control with the average cost consumption index of 1.93, and the second ward of orthopedics has the best cost control with the average cost consumption index of 0.91. For the time consumption index, the average time consumption index of the six wards was less than 1, and the average length of hospital stay was well controlled. Conclusions Orthopedic hospitalization days were well controlled, and the difficulty of admission in Orthopedic ward 5 was relatively low, and the cost and time efficiency needed to be improved. Orthopedics refined performance management into each DRGs group, CMI value could distinguish the difficulty and workload of different departments. These could more objectively and truly reflect the level of medical work. Through

关 键 词：疾病诊断相关分组 骨科 医疗控费管理 费用消耗指数 综合诊疗难度 

分 类 号：R197.322[医药卫生—卫生事业管理]