基于DRG医保付费的手术病种临床路径精益化管理效果研究  

Research on the effect of lean management of clinical pathway of surgical diseases base on DRG medical insurance payment

作　　者：莫夏丽 何慧敏 MO Xiali;HE Huimin(Department of Quality Control,Guangxi Zhuang Autonomous Region Minzu Hospital,Guangxi Zhuang Autonomous Region,Nanning 530001,China;School of Information Management,Guangxi Medical University,Guangxi Zhuang Autonomous Region,Nanning 537406,China)

机构地区：[1]广西壮族自治区民族医院质控科,广西南宁530001 [2]广西医科大学信息与管理学院,广西南宁537406

出　　处：《中国医药导报》2023年第16期162-167,共6页China Medical Herald

基　　金：广西壮族自治区卫生健康委员会立项课题(Z20200423);广西壮族自治区研究生教育创新计划项目(JGY2020046)。

摘　　要：目的探讨在诊断相关分组(DRG)医保付费方式改革背景下,精益化管理(LM)对手术病种临床路径(CP)的管理成效。方法以广西壮族自治区民族医院实施CP管理的13个手术病种为研究对象,2020年(应用LM前)为对照组,2021年(应用LM后)为实验组,比较核心指标的改善幅度,评价LM在手术病种CP中的实施效果。结果实验组完成率为87.42%,对照组完成率为84.14%。实验组腹腔镜下阑尾切除术、经输尿管镜气压弹道碎石取石术、乳腺良性肿瘤切除术、冠状动脉支架植入术、颈动脉支架植入术入组完成率高于对照组,差异有统计学意义(P<0.05)。实验组变异完成率为19.37%,对照组变异完成率为21.77%。实验组腹腔镜下子宫次全切除术、腹腔镜下阑尾切除术、内镜下结直肠息肉切除术、甲状腺次全切除术、冠状动脉支架植入术、颈动脉支架植入术变异完成比例低于对照组,差异有统计学意义(P<0.05)。实验组手术并发症发生率为2.60%,对照组为3.33%。实验组腹腔镜下子宫次全切除术、腹腔镜下阑尾切除术、内镜下结直肠息肉切除术、甲状腺次全切除术、冠状动脉支架植入术并发症发生率低于对照组,差异有统计学意义(P<0.05)。实验组内镜下腰椎间盘切除术治愈好转率高于对照组,差异有统计学意义(P<0.05)。大部分病种平均住院日、平均术前住院日低于对照组,差异有统计学意义(P<0.05)。实验组次均住院费用、次均药品费用及次均耗材费用均有不同程度的降低,差异有统计学意义(P<0.05)。结论LM对手术病种的CP管理有显著改善效果,能有效改善手术病种的总量、效率、效益及质量指标,提高医院病种管理水平。Objective To explore the effect of lean management(LM)on clinical pathway(CP)of surgical diseases under the background of medical insurance payment reform of diagnosis related groups(DRG).Methods Taking 13 surgical diseases under CP management in ethnic hospitals of Guangxi Zhuang Autonomous Region as the research object,2020(before LM application)as the control group,2021(after LM application)as the experimental group,the improvement of core indicators were compared,and the implementation effect of LM in surgical diseases CP was evaluated.Results The completion rate of the experimental group was 87.42%and that of the control group was 84.14%.The completion rates of laparoscopic appendectomy,ureteroscope pneumatic lithotripsy,breast benign tumor resection,coronary artery stenting,and carotid artery stenting in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05).The mutation completion rate was 19.37%in the experimental group and 21.77%in the control group.Laparoscopic hysterectomy,laparoscopic appendectomy,endoscopic colorectal polypectomy,endoscopic thyroidectomy,coronary artery stenting,and carotid artery stenting in the experimental group were lower than those in the control group,with statistical significances(P<0.05).The incidence of surgical complications was 2.60%in the experimental group and 3.33%in the control group.The complication rates of laparoscopic subtotal hysterectomy,laparoscopic appendectomy,endoscopic colorectal polypectomy,subtotal thyroidectomy and coronary stenting in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05).The average hospital stay and average preoperative hospital stay of most diseases were lower than those of control group,and the differences were statistically significant(P<0.05).In the experimental group,average hospitalization cost,average drug cost and average consumables cost were decreased in different degrees,the differences

关 键 词：精益化管理 临床路径 诊断相关分组 手术病种 医保付费方式改革 

分 类 号：R197.32[医药卫生—卫生事业管理]