CHS-DRG付费改革对医院医疗质量和运行效率影响的实证分析  

Empirical analysis of the impact of CHS-DRG payment reform on hospital medical quality and operational efficiency

作　　者：张淑琴[1] 李雅萍 ZHANG Shuqin;LI Yaping(Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院,北京100020

出　　处：《卫生软科学》2024年第5期10-15,共6页Soft Science of Health

摘　　要：[目的]分析北京市某三甲医院在CHS-DRG实际付费改革前、后的医院医疗质量和运行效率的变化情况,评价改革实施效果。[方法]通过Donabedian模型建立指标集,收集其中8个指标2021年4月-2023年3月的住院数据进行中断时间序列分析。[结果]CHS-DRG付费改革后,CMI值在改革时短暂下降了0.04,但后续呈上升趋势(P<0.05),显示在长期受到了政策正向的积极影响;平均住院日在观测期内水平下降0.183天,但改革后趋势显著上升(P<0.05);住院例均费用在改革时显著下降,降低了493.45元,但改革后趋势变为上升;费用消耗指数在改革后变为上升趋势(P<0.05)。[结论]CHS-DRG支付改革推动了技术难度的提升、平均住院日和患者医疗经济负担的即时下降,但改革后长期的时间消耗和费用消耗未得到显著优化。Objective To analyze the changes of the hospital medical quality and operational efficiency of a tertiary hospital in Beijing before and after the CHS-DRG payment reform,and to evaluate the effect of reform implementation.Methods The Donabedian model was used to establish an indicator set,and the hospitalization data of eight indicators from April 2021 to March 2023 were collected for interrupted time series analysis.Results After the CHS-DRG payment reform,the CMI value decreased briefly by 0.04 during the reform,but then showed an upward trend(P<0.05),indicating that it was positively affected by the policy in the long term.The average length of stay decreased by 0.183 days during the observation period,but the trend increased significantly after the reform(P<0.05).The average hospitalization cost decreased significantly by 493.45 yuan during the reform,but it showed an upward trend after the reform.The cost consumption index showed an upward trend after the reform(P<0.05).Conclusions The CHS-DRG payment reform has improved the technology,and reduced the average length of hospital stay and patients'financial burden.However,the long-term time consumption and cost consumption have not been significantly optimized after the reform.

关 键 词：Donabedian模型 CHS-DRG付费改革 医院医疗质量 医院运行效率 

分 类 号：R197[医药卫生—卫生事业管理]