基于RBRVS以主手术为核心的手术绩效管理模式实证研究  

Empirical study on surgical performance management model based on RBRVS with main surgery as the core

作　　者：吴沁怡 王军[1] 徐姁 宋文洁 文黎敏 WU Qinyi;WANG Jun;XU Xu;SONG Wenjie;WEN Limin(West China School of Medicine/West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西临床医学院/华西医院,成都610041

出　　处：《中国循证医学杂志》2024年第8期899-903,共5页Chinese Journal of Evidence-based Medicine

基　　金：2023年“四川大学党政服务管理”项目(编号:2023DZYJ-44)。

摘　　要：目的基于H医院本土化的以资源为基础的相对价值量表(resource-based relative value scale,RBRVS)实施以主手术为核心的手术绩效管理模式改革,构建更加科学公平的手术绩效分配体系。方法构建以主手术为核心的手术绩效管理模式,收集整理H医院2023年全年65915台住院择期手术的RBRVS、疾病诊断相关分组(diagnosis related groups,DRG)、病例组合指数(case mixed index,CMI)、手术时间等相关数据,采用SPSS软件进行大样本历史数据分析,通过关键指标验证优化后手术绩效管理模式的合理性。结果纳入研究的22个科室多条医嘱手术总系数与主手术系数均高度拟合(γ>0.85),各专科匹配系数均差异显著(P<0.001),以主手术为核心的手术绩效管理模式对关键指标(医生时间资源投入和手术风险难度)的体现得到明显提升。结论通过实施以主手术为核心的手术绩效管理模式,强化体现诊疗风险及难易程度、医生劳务价值的绩效导向,引导临床回归医疗本质,支撑学科建设发展,进一步激发临床工作活力和动力。Objective Based on the localization of resource-based relative value scale(RBRVS)in H Hospital,to implement a surgical performance management model reform with the main surgery as the core,and to construct a more scientific and fair surgical performance distribution system.Methods A surgical performance management model with the main surgery as the core was constructed.Relevant data such as RBRVS,diagnosis related groups(DRG),case mixed index(CMI),and surgical time of 65915 inpatient elective surgeries in H Hospital in 2023 were collected and organized.Large sample historical data analysis was conducted using SPSS software,and the rationality of the optimized surgical performance management model was verified through key indicators.Results The total coefficient of multiple orders for surgery in the 22 departments included in the study was highly correlated with the main surgery coefficient(γ>0.85),and the matching coefficients for each specialty were significantly different(P<0.001).The surgical performance management model with the main surgery as the core showed a significant improvement in the key indicators(doctor’s time resource investment and surgical risk and difficulty).Conclusion By implementing a surgical performance management model with the main surgery as the core,we aim to strengthen the performance orientation that reflects the risks and difficulty of diagnosis and treatment,as well as the value of doctor services.This will guide clinical practice to return to the essence of medicine,support the development of discipline construction,and further stimulate the vitality and motivation of clinical work.

关 键 词：手术绩效管理 主手术 以资源为基础的相对价值量表 疾病诊断相关分类 回归分析 

分 类 号：R197.32[医药卫生—卫生事业管理]