基于中断时间序列分析DRG对公立医院高质量发展的影响  

Impacts of DRG on the high-quality development of public hospitals based on interruption time series analyses

作　　者：叶娟[1] 金卉[1] 曾冠玉 何青[1] 何彬婵 蒋丽萍 陈密思 YE Juan;JIN Hui;ZENG Guan-yu;HE Qing;HE Bin-chan;JIANG Li-ping;CHEN Mi-si(Department of Medical Insurance,The Second Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530007,China)

机构地区：[1]广西医科大学第二附属医院,医疗保险科,广西壮族自治区南宁市530007

出　　处：《现代预防医学》2024年第10期1828-1832,共5页Modern Preventive Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20201129);广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220668);2021年度广西高校中青年教师科研基础能力提升项目(2021KY0072)。

摘　　要：目的了解DRG医保支付方式改革对广西某三级综合医院质量发展的影响。方法选取该院2020—2021年全部住院结算病例数据,按照广西基本医疗保险DRG分组方案(1.0版)测算所有病例的DRG分组,采用中断时间序列分析法,分析医院2020年12月DRG政策实施前后总权重数、病例组指数、费用消耗指数、时间消耗指数、平均住院天数、次均住院费用等DRG指标的水平变化和趋势变化,进一步从医院医疗服务能力、医疗服务效率、医疗安全等方面评价DRG对公立医院质量发展的影响。结果本研究共纳入72089例出院病例,费用消耗指数(β=-0.242,P=0.001)、时间消耗指数(β=-0.119,P=0.002)、平均住院天数(β=-1.543,P=0.011)、高倍率病例占比(β=-0.028,P=0.026)、住院次均费用(β=-3669.366,P=0.026)在实施DRG政策时出现即刻水平下降。结论该院实施DRG政策改革后,医疗服务效率明显提升,但仍面临调结构增质量的挑战。Objective To evaluate the impact of DRG medical insurance payment reform on the quality development of a tertiary comprehensive hospital in Guangxi.Methods This study selected data on all inpatient settlement cases in the hospital from 2020 to 2021,and calculated the DRG grouping of all cases according to the national CHS-DRG version 1.0 grouping plan.The interruption time series analysis method was further used to analyze the level and trend changes of indicators after the DRG policy reform in hospitals in December 2020.These indicators included total weight,case group index,cost consumption index,time consumption index,average length of stay,average hospitalization cost per visit,etc.They were used to evaluate the hospital’s medical service capacity,medical service efficiency,and medical safety,in order to understand the quality of the hospital.Results A total of 72089 cases were included in this study.Indicators such as cost consumption index(β=-0.242,P=0.001),time consumption index(β=-0.119,P=0.002),average length of stay(β=-1.543,P=0.011),proportion of high incidence cases(β=-0.028,P=0.026),and average cost of hospitalization(β=-3669.366,P=0.026)showed an immediate decrease during the implementation of DRG policy.Conclusion After implementing the DRG policy reform,the hospital has significantly improved the efficiency of medical services,but still faces the challenge of adjusting structure and increasing quality.

关 键 词：DRG 公立医院 医院高质量 中断时间序列分析 

分 类 号：R197.32[医药卫生—卫生事业管理]