人员培训对上海市三级综合医院DRG付费改革准备度的影响  

The Impact of Personnel Training on the Readiness for DRG Payment Reform in Tertiary General Hospitals in Shanghai

作　　者：袁素维 罗诚祖[1] YUAN Suwei(Office of the President,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院院长办公室,上海200127

出　　处：《医学与社会》2024年第8期79-85,共7页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为72004136。

摘　　要：目的:评估人员培训对上海市三级综合医院DRG付费改革准备度的影响,为推进医保支付方式改革提供参考。方法:于2022年8-9月对上海市7家三级综合医院的724名医务人员开展问卷调查,评估不同强度的人员培训对医务人员DRG付费改革准备度的影响,并采用结构方程模型检验组织文化在其中的中介效应。结果:参与调查的医务人员接受3次及以上培训的比例不足50%。上海市三级综合医院对DRG付费改革准备度总得分(3.59±0.96)分,其中变革效能得分(3.63±0.96)略高于变革承诺(3.52±1.00)。人员培训强度对医院改革准备度影响的总效应为26.3%,组织文化因素在其中的间接中介效应为11.3%。结论:当前针对医务人员的DRG付费改革培训存在不足,医院对DRG付费改革的准备度总体处于中等水平,组织文化在人员培训影响医务人员改革准备度中发挥间接中介效应。建议政府医保部门和医院管理者加大培训力度,帮助医务人员尽快适应改革;同时在政策执行过程中加强对改革准备度的评估研究。Objective:To evaluate the impact of personnel training on the readiness for DRG payment reform in tertiary general hospitals in Shanghai,providing a reference for advancing medical insurance payment reform.Methods:A questionnaire survey was conducted among 724 medical staff from seven tertiary general hospitals in Shanghai from August to September 2022 to assess the impact of different intensities of training on the readiness for DRG reform.The mediating effect of organizational culture was examined using a structural equation model.Results:Less than 50%of the surveyed medical staff received training three times or more.The overall readiness score for DRG payment reform in tertiary general hospitals in Shanghai was(3.59±0.96),with the score for change efficacy(3.63±0.96)slightly higher than that for change commitment(3.52±1.00).The total effect of training intensity on the level of hospital readiness for reform was 26.3%,with an indirect mediating effect of organizational culture accounting for 11.3%.Conclusion:The current training for medical staff on DRG payment reform is insufficient,and the overall readiness for DRG payment reform in hospitals is at a moderate level.Organizational culture plays an indirect mediating role in the impact of training intensity on the readiness for reform among medical staff.It is recommended that government medical insurance departments and hospital administrators increase training efforts to help staff quickly adapt to the reform.Additionally,it is necessary to strengthen the evaluation of readiness for reform during policy implementation.

关 键 词：DRG付费改革 准备度 培训 三级综合医院 上海 

分 类 号：R-05[医药卫生]