借力DRG支付模式 提升医疗质量安全  

Improving Medical Quality and Safety Through DRG Payment Model

作　　者：周炯 王书畅 马小军[1] ZHOU Jiong;WANG Shuchang;MA Xiaojun(Department of Medical Affairs,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院医务处,北京100730

出　　处：《协和医学杂志》2024年第5期981-986,共6页Medical Journal of Peking Union Medical College Hospital

基　　金：北京协和医学基金会医务管理发展研究公益项目(22323034001)。

摘　　要：在医疗支付面临老龄化社会与医保可持续性挑战的当下,疾病诊断相关分组(diagnosis related group,DRG)不仅是支付管理工具,且涉及预算管理、医疗质量安全等多个方面,构建了全面的医疗管理工具组套。然而,如何进一步发掘DRG支付模式的潜力、激发内生动力、充分发挥其正向激励作用,仍需不断探索和实践。本文从诊疗规范化、指南本土化、医源性损害最小化、经济学评价普及化等维度展开,阐述在DRG支付模式下如何优化诊疗流程、规范诊疗行为,以及应对平衡成本控制与临床技术创新的挑战与机遇。Amid challenges of adapting to an aging society and maintaining sustainable healthcare fi⁃nancing,DRG forms a comprehensive suite of healthcare management tools,serving not only as a payment management tool but also encompassing budget management and healthcare quality control.However,further exploration of DRG's potential,which includes stimulating intrinsic motivations,and maximizing its positive incentive effects,requires continuous exploration and implementation.This paper discusses the standardization of clinical practices,localization of guidelines,minimization of iatrogenic harm,and popularization of economic evaluation,with the aiming of optimizing clinical pathways,standardizing medical practices,and balancing the challenges and opportunities of cost control and clinical innovation under the DRG payment model.

关 键 词：DRG 支付模式 医疗质量安全 规范诊疗 经济学评价 成本控制 

分 类 号：R197.3[医药卫生—卫生事业管理] F840.684[医药卫生—公共卫生与预防医学] F224.5[经济管理—保险]