DRG支付方式改革下医务人员体验感知调查研究  

Investigation on Medical Staff's Experience Perception under DRG Payment Reform

作　　者：陈锦 李园园 柏杨 李燕 叶静 潘宏冉 张萍 廖通权 符美玲[3] 周建云 CHEN Jin;LI Yuanyuan;BAI Yang(The Second Affiliated Hospital,Army Medical University,Chongqing,400037,China;不详)

机构地区：[1]陆军军医大学第二附属医院,重庆400037 [2]陆军军医大学第一附属医院,重庆400038 [3]重庆医科大学附属第一医院,重庆400042

出　　处：《中国卫生质量管理》2024年第7期41-46,共6页Chinese Health Quality Management

基　　金：重庆市教委重点项目(编号:232165);陆军军医大学人文社科课题(编号:2022XRW20)。

摘　　要：目的对疾病诊断相关分组(DRG)支付方式改革下医务人员体验感知进行调查,为推动医保改革提供参考。方法通过问卷调查重庆市23家DRG试点医院医务人员体验感知情况,并进行DRG支付改革激发医务人员积极性的单因素分析和多元线性回归分析,采用SPSS 25.0软件进行数据统计处理。结果“医院医保管理”得分最高,为(4.27±0.77)分;“DRG支付改革”得分最低,为(3.51±1.05)分;影响DRG支付方式改革激发医务人员积极性的单因素分别为性别、年龄、医院等级、科室、职务、岗位、学历、职称、工作年限(P<0.05),其中学历、年龄、岗位、医院等级是关键影响因素;DRG付费下医生采取的正向行为主要为规范医疗行为(74.88%)、推行临床路径(72.76%)、优化诊疗和服务流程(65.56%)等,负向行为主要为挑选权重值高的患者(62.60%)、推诿可能超支的患者(60.69%)、分解住院(45.59%)等。结论DRG支付方式改革下医务人员体验总体感知处于中等偏上水平。应关注患者安全与创新技术发展的平衡性,及时调整医务人员绩效分配与激励机制,以及DRG核心分组方案和医保支付标准,减少医务人员负向应对行为。Objective To investigate the experience perception of medical personnel under the payment method reform of Diagnosis Related Groups(DRG),and provide reference for promoting medical insurance reform.Methods A questionnaire survey was conducted to investigate the experience perception of medical staff in 23 DRG pilot medical institutions in Chongqing,and a single factor analysis and multiple linear regression analysis were carried out to stimulate the enthusiasm of medical staff through DRG payment reform.SPSS 25.0 software was used for data analysis.Results"Hospital medical insurance management"scored the highest(4.27±0.77),and the score for"DRG payment reform"was the lowest(3.51±1.05).In terms of motivating medical staff enthusiasm,there were statistically significant differences among nine subgroups characterized by gender,age,hospital level,department,position,job title,education level,professional title,and work experience(P<0.05).Among these,education level,age,job position and hospital level were key influencing factors.The positive behaviors taken by doctors under DRG payment mainly included standardizing medical behaviors(74.88%),promoting clinical pathways(72.76%),optimizing diagnosis,treatment and service processes(65.56%),etc.The negative behaviors were mainly to select patients with high weight value(62.60%),patients with possible overspending on bucking(60.69%),and decomposed hospitalization(45.59%).Conclusion Under the reform of DRG payment method,the overall perception of medical staff's experience was above the medium level.It should pay attention to the balance between patient safety and innovative technology development,timely adjust the performance allocation and incentive mechanism of medical staff,as well as the DRG core grouping scheme and medical insurance payment standard,and reduce the negative coping behavior of medical staff.

关 键 词：疾病诊断相关分组 医保 医务人员 体验感知 诊疗行为 

分 类 号：R197.323[医药卫生—卫生事业管理]