总额控制下疾病诊断相关分组支付方式改革前后不同临床科室评价指标的比较研究  

A comparative study of evaluation indicators of different clinical departments before and after the reform of diagnosis-related group payment method under total amount control

作　　者：刘可心 程永忠[3,4] LIU Kexin;CHENG Yongzhong(Medical Equipment Department,Panzhihua Central Hospital,Panzhihua,Sichuan 617067,P.R.China;Business School,Sichuan University,Chengdu,Sichuan 610065,P.R.China;Party Committee Office,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Institute of Hospital Management,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]攀枝花市中心医院医学装备部,四川攀枝花617067 [2]四川大学商学院,成都610065 [3]四川大学华西医院党委办公室,成都610041 [4]四川大学华西医院医院管理研究所,成都610041

出　　处：《华西医学》2023年第12期1819-1823,共5页West China Medical Journal

基　　金：攀枝花市指导性科技计划项目(2020ZD-S-5)。

摘　　要：目的探讨在总额控制下疾病诊断相关分组(diagnosis-related group,DRG)支付方式改革对神经内科和神经外科的影响。方法采集攀枝花市中心医院神经内科和神经外科2018年1月—2020年12月DRG分组数据,选取国内成熟的DRG评价指标,利用中断时间序列分析法,对2019年7月该院绩效考核方案改革前后两个科室的DRG评价指标进行比较。结果神经内科和神经外科在DRG支付下整体医疗服务能力均呈缓慢下降趋势。神经内科医疗服务效率有所提升,同时医疗费用消耗呈缓慢下降趋势;神经外科医疗服务效率缓慢下降,同时医疗费用消耗呈缓慢上升趋势。从中断时间序列分析结果来看,神经外科总权重在干预前呈显著下降趋势(β_(1)=−5.526,P=0.003),干预后下降趋势放缓,干预前后的斜率差异有统计学意义(β_(3)=4.546,P=0.047);病例组合指数在干预前呈下降趋势(β_(1)=−0.050,P<0.001),干预后无明显下降趋势,干预前后的斜率差异有统计学意义(β_(3)=0.052,P=0.001);费用消耗指数在干预前无明显变化趋势(β_(1)=−0.006,P=0.258),干预后呈上升趋势,干预前后的斜率差异有统计学意义(β_(3)=0.027,P=0.032)。而该考核方案对神经内科的影响无统计学意义(P>0.05),需要进一步观察。结论总额控制下DRG支付方式改革对于不同性质的临床科室的评价指标影响不相同。建议对不同性质临床科室进行分类管理和考核。Objective To explore the impact of diagnosis-related group(DRG)payment method reform under total amount control on neurology and neurosurgery departments.Methods The DRG grouping data of the Department of Neurology and the Department of Neurosurgery of Panzhihua Central Hospital from January 2018 to December 2020 were collected,and the mature DRG evaluation indexes in China were selected.Using the interrupt time series analysis method,the DRG-related indexes of the two departments before and after the introduction of the performance appraisal plan in July 2019 were compared,to evaluate the intervention effects on the two departments.Results Both neurology and neurosurgery departments showed a slow downward trend in the overall medical service capacity under the DRG payment.The efficiency of medical services showed a slow upward trend and the consumption of medical expenses showed a slow downward trend in the Department of Neurology,while the efficiency of medical services showed a slow downward trend and the consumption of medical expenses showed a slow upward trend in the Department of Neurosurgery.According to the results of interrupt time series analysis,in the Department of Neurosurgery,the total weight showed a significant downward trend before intervention(β_(1)=−5.526,P=0.003),and the downward trend became sluggish after intervention,with a statistically significant slope difference before and after intervention(β_(3)=4.546,P=0.047);the case-mix index showed a downward trend before intervention(β_(1)=−0.050,P<0.001),and no obvious trend after intervention,with a statistically significant slope difference before and after intervention(β_(3)=0.052,P=0.001);the cost consumption index showed no obvious downward trend before intervention(β_(1)=−0.006,P=0.258),and an upward trend after intervention,with a statistically significant slope difference before and after intervention(β_(3)=0.027,P=0.032).The impact of this assessment plan on the Department of Neurology was not statistically significant(P>0.

关 键 词：医疗保险支付方式改革 疾病诊断相关分组 中断时间序列分析法 科室评价 

分 类 号：R197.3[医药卫生—卫生事业管理]