南平市某三甲医院实施CHS-DRG对医疗服务质量及效率的影响研究  

Study on the impact of CHS-DRG on the quality and efficiency of medical services in a tertiary grade A hospital in Nanping City

作　　者：赖乐涵 陈礼江 蒋凌 商云清 LAI Lehan;CHEN Lijiang;JIANG Ling;SHANG Yunqing(Quality Management Department,Nanping First Hospital Affiliated to Fujian Medical University,Nanping Fujian 353000,China;Medical Records and Statistics Department,Nanping First Hospital Affiliated to Fujian Medical University,Nanping Fujian 353000,China)

机构地区：[1]福建医科大学附属南平第一医院,福建南平353000

出　　处：《卫生软科学》2024年第9期79-83,共5页Soft Science of Health

基　　金：福建省卫生健康科技计划项目软科学研究项目(2022RKA016);福建医科大学启航基金项目(2021QH1224)。

摘　　要：[目的]探究CHS-DRG支付方式对南平市某三甲医院医疗质量及效率的影响程度,为提升医疗服务质量及效率,推进DRG支付方式改革提供参考。[方法]选取南平市某三甲医院2020年8月-2022年7月DRG出院患者的住院数据共97564例。选取CMI值、药占比、四级手术占比作为医疗服务质量指标,选取总权重、费用消耗指数、时间消耗指数作为医疗服务效率指标,采用间断时间序列分析其在CHS-DRG支付方式运行前后的趋势变化。[结果]医疗服务质量方面,CMI、四级手术占比和药占比在DRG实施前后的差异均有统计学意义(P<0.05),与实施前相比,CMI(β_(1)+β_(3)=0.002)和四级手术占比(β_(1)+β_(3)=0.142)增长速度放缓,药占比则由上升转为下降(β_(1)+β_(3)=-0.229);医疗服务效率方面,总权重、费用消耗指数和时间消耗指数在实施前后的差异均有统计学意义(P<0.05),与实施前相比,总权重上升趋势加快(β_(1)+β_(3)=159.505),费用消耗指数下降趋势变缓(β_(1)+β_(3)=-0.001),时间消耗指数下降趋势加快(β_(1)+β_(3)=-0.008)。[结论]实施CHS-DRG对地市级三甲医院医疗服务质量与效率影响显著,CHS-DRG付费背景下公立医院兼顾医疗服务质量与效率具有挑战性。建议公立医院加强成本管控,进行精细化管理,同时加强监督考核,提质增效。Objective This paper explores the impact of CHS-DRG payment method on the medical quality and efficiency of a tertiary grade A hospital in Nanping to provide the reference for improving the quality and efficiency of medical services and promoting the reform of DRG payment method.Methods Data of 97564 discharged patients with DRG were selected from a tertiary grade A hospital in Nanping City from August 2020 to July 2022.CMI value,the proportion of drugs and the proportion of level four surgery were selected as indicators of medical service quality.The total weight,charge consumption index and time consumption index were selected as indicators of medical service efficiency.Interrupted Time Series Analysis was used to analyze trend changes before and after CHS-DRG payment.Results In terms of medical service quality,differences of CMI,the proportion of level four surgery and the proportion of drugs before and after the implementation of DRG were statistically significant(P<0.05).Compared with before DRG implementation,the growth rate of CMI(β_(1)+β_(3)=0.002)and the proportion of level four surgery(β_(1)+β_(3)=0.142)slowed down,while the proportion of drugs changed from increasing to decreasing(β_(1)+β_(3)=-0.229).In terms of medical service efficiency,differences of total weight,charge consumption index and time consumption index before and after DRG implementation were statistically significant(P<0.05).Compared with before DRG implementation,the upward trend of total weight has accelerated(β_(1)+β_(3)=159.505);the downward trend of charge consumption index has slowed down(β_(1)+β_(3)=-0.001),and the downward trend of time consumption index has accelerated(β_(1)+β_(3)=-0.008).Conclusions The implementation of CHS-DRG has a significant impact on the quality and efficiency of medical services in tertiary grade A hospitals at the municipal level.Under the background of CHS-DRG payment,it is challenging for public hospitals to balance the quality and efficiency of medical services.It is recommended that pub

关 键 词：CHS-DRG 医疗服务质量 医疗服务效率 间断时间序列分析 高质量发展 

分 类 号：R197[医药卫生—卫生事业管理]