临床专科评价的DRG细化分组机制研究  

DRG Refinement Grouping Mechanism of Clinical Specialty Departments Evaluation

作　　者：沈婷[1,2] 于海跃 钟力炜 朱佳云 张娴静 李群 朱乐兰[4] SHEN Ting;YU Haiyue;ZHONG Liwei(Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200071,China;不详)

机构地区：[1]上海中医药大学附属市中医医院,上海200071 [2]市级医院病种质量与安全研究中心,上海200071 [3]上海申康医院发展中心,上海200041 [4]上海市第一人民医院,上海200080

出　　处：《中国卫生质量管理》2024年第3期12-14,20,共4页Chinese Health Quality Management

基　　金：国家自然科学基金国际(地区)合作与交流项目(编号:72211530040);上海市医院协会医院管理研究基金(编号:X2020076);上海申康医院发展中心临床科技创新项目(编号:SHDC22021204)。

摘　　要：目的将细分后的DRG分组作为临床专科评价工具,为专科评价提供参考。方法邀请20余名相关专家进行专题讨论,将CHS-DRG现有的376组ADRG组按国家《医疗机构诊疗科目名录》细分为460组,分入42个专科。结果有277组归属唯一专科;有57组被拆分为两个专科;有19组被拆分为两个以上专科;另有23组不进行细分,其中5组在国家医疗保障局细分组方案中未见具体编码。结论基于细分后的DRG分组,可准确归属专科并开展临床专科评价,有利于促进优势专科能力建设。依据不同专科特点,增加更具有针对性的考核要素,有助于进行精细化绩效评价。Objective The refined DRG group is used as an evaluation tool for clinical departments to provide reference for specialty evaluation.Methods More than 20 relevant experts were invited to have a thematic discussion,and 376 ADRG groups existing in CHS-DRG were subdivided into 460 groups,according to the national"Medical Institution Diagnosis and Treatment Subjects Directory"and grouped into specialties,which were divided into 42 specialties.Results 277 groups belonged to the only specialty;57 groups were divided into 2 specialties;19 groups were divided into two or more specialties;another 23 groups were not subdivided.Five groups did not had the specific code in the National Healthcare Security Administration subgroup plan.Conclusion Based on the refinement DRG group,it can be accurately classified into specialties and carry out clinical specialty evaluation,which is conducive to promoting the capacity building of superior specialties.According to the characteristics of different specialties,more targeted assessment elements could be added to help to carry out fine performance evaluation.

关 键 词：DRG 细分组 专科评价 专科建设 

分 类 号：R197.3[医药卫生—卫生事业管理]