基于DRG评价的精神病医院医疗质量分析  

Analysis of medical quality in psychiatric hospitals based on DRG evaluation

作　　者：潘轶竹[1] 郭默宁 仇叶龙[3] 李晓虹 佘永军[5] 陈浩[6] 肖存利 孙秀琪 李志武 Pan Yizhu;Guo Moning;Qiu Yelong;Li Xiaohong;She Yongjun;Chen Hao;Xiao Cunli;Sun Xiuqi;Li Zhiwu(Medical Service Department,Beijing Anding Hospital,Capital Medical University,Beijing 100088,China;Office of Beijing Medical Big Data and Policy Research Center,Beijing 100031,China;Medical Service Department,Xuanwu Hospital of Capital Medical University,Beijing 100053,China;Dean′s Office,Beijing Huilongguan Hospital,Beijing 102208,China;Medical Service Department,The Sixth Hospital of Peking University,Beijing 100191,China;Dean′s Office,Beijing Chaoyang District Third Hospital,Beijing 100025,China;Deans Office,Beijing Xicheng District Ping′an Hospital,Beijing 100055,China;Medical Service Department,Beijing Daxing Xinkang Hospital,Beijing 102699,China;Dean′s Office,Beijing Fengtai Mental Health Center,Beijing 100074,China)

机构地区：[1]首都医科大学附属北京安定医院医务处,北京100088 [2]北京市医疗大数据与政策研究中心办公室,北京100031 [3]首都医科大学宣武医院医务处,北京100053 [4]北京回龙观医院院长办公室,北京102208 [5]北京大学第六医院医务处,北京100191 [6]北京市朝阳区第三医院院长办公室,北京100025 [7]北京市西城区平安医院院长办公室,北京100055 [8]北京市大兴区心康医院医务处,北京102699 [9]北京丰台心理卫生中心院长办公室,北京100074

出　　处：《中华医院管理杂志》2023年第1期22-26,共5页Chinese Journal of Hospital Administration

基　　金：2021年度北京市医院管理中心培育计划(PG2021033)。

摘　　要：目的基于疾病诊断相关分组(DRG)评价北京市精神病医院的医疗服务质量,分析评价效果,为构建适用于精神病医院的DRG绩效评价体系提供依据。方法从北京地区住院医疗绩效服务评价平台提取2018—2020年北京市14家三级和二级精神病医院住院患者的DRG数据,分析医院DRG绩效评价指标以及DRG入组病例平均住院日和例均费用。所有数据采用描述性研究方法,组间比较采用曼-惠特尼U检验。结果2018—2020年,三级医院平均DRG组数(28)高于二级医院(10)(P<0.05),平均CMI值与二级医院相同(1.79),平均费用消耗指数(1.15)高于二级医院(0.65)(P<0.05),平均时间消耗指数(1.11)略低于二级医院(1.30),低风险组死亡率(0.01%)整体低于二级医院(0.88%),DRG入组住院病例占出院病例的百分比均值(82.8%)高于二级医院(27.3%)(P>0.05)。三级和二级医院DRG入组病例平均住院日和例均费用均低于医院总体出院病例(P<0.05)。结论DRG组数、CMI值和低风险组死亡率可用于精神病医院医疗服务能力和安全评价,但费用及时间消耗指数不能客观反映医院医疗服务效率,DRG绩效评价指标更适用于评价短期住院的精神疾病患者。建议将DRG入组病例比例作为精神病医院服务质量评价的潜在指标。Objective To evaluate the medical service quality of psychiatric hospitals in Beijing based on diagnostic related group(DRG),analyze the evaluation effect,for refences to constructe a DRG performance evaluation system suitable for psychiatric hospitals.Methods This study extracted data such as the number of DRG groups,etc.of hospitalized patients in 14 tertiary and secondary psychiatric hospitals in Beijing from 2018 to 2020 from the Beijing inpatient medical performance evaluation platform,and analyzed data on DRG performance evaluation indicators,as well as the average length of hospital stay and average cost of DRG enrolled cases.All data were analyzed using descriptive research methods,and inter group comparisons were conducted using the Mann Whitney U-test.Results From 2018 to 2020,the average number of DRG groups in tertiary hospitals(28)was higher than that in secondary hospitals(10)(P<0.05),and the average CMI values of both were the same(1.79);The average cost consumption index(1.15)of tertiary hospitals was higher than that of secondary hospitals(0.65)(P<0.05),while the average time consumption index(1.11)was slightly lower than that of secondary hospitals(1.30);The mortality rate of the low-risk group in tertiary hospitals(0.01%)was generally lower than that in secondary hospitals(0.88%),and the average percentage of DRG admitted inpatients(82.8%)was significantly higher than that in secondary hospitals(27.3%)(P>0.05).The average length of stay and cost per case for DRG enrolled inpatients in tertiary and secondary hospitals were lower than the overall hospital discharge cases(P<0.05).Conclusions The number of DRG groups,CMI value,and low-risk mortality rate could be used for evaluating the medical service capacity and safety of psychiatric hospitals,but the cost and time consumption index could not objectively reflect the efficiency of hospital medical services.DRG performance evaluation indicators are more suitable for evaluating short-term hospitalization of psychiatric patients.The proportion of DR

关 键 词：疾病诊断相关分组 精神病医院 医疗质量评价 诊疗服务 医院管理 

分 类 号：R197.5[医药卫生—卫生事业管理]