DRG支付方式改革下基于病组成本标杆的公立医院绩效管理实践  

Performance management in public hospital based on the benchmark of disease group cost under diagnosis related groups payment reform

作　　者：张丽娜[1] 蒋银芬[1] 孙亮[1] 张丽湘[1] 黄隽英[1] 徐博[2] 魏钦海[2] 周倩[1] 王宇[3] Zhang Lina;Jiang Yinfen;Sun Liang;Zhang Lixiang;Huang Juanying;Xu Bo;Wei Qinhai;Zhou Qian;Wang Yu(Operation Performance Department/Health Insurance and Price Department,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Dean′s Office,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Information Center,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院运营绩效处/医保物价处,苏州215004 [2]苏州大学附属第二医院院长室,苏州215004 [3]苏州大学附属第二医院信息中心,苏州215004

出　　处：《中华医院管理杂志》2024年第8期594-598,共5页Chinese Journal of Hospital Administration

基　　金：江苏省医院协会重大课题(JSYGY-1-2021-PJ140);江苏省医院协会课题(JSYGY-2021-JY10)。

摘　　要：以按疾病诊断相关分组(DRG)支付方式改革为契机,开展基于病组的绩效管理是促进医院提升诊疗水平和高质量发展的重要抓手。2023年,某三级甲等综合医院将标杆管理法引入绩效管理中,以病组的平均住院日、药品费和耗材费作为成本标杆指标,主要基于所在地区三级甲等医院的病组大数据和某院的临床路径管理目标,通过多维度、多层次地比较分析各病组标杆指标的医院历史值和地区大数据分布值等确定各病组的成本标杆值。该院基于病组成本标杆值建立了绩效奖惩机制,同时建立了绩效管理沟通机制,以促进相关科室和医疗组对照标杆完善管理。此外,随着外部环境和内部实践的变化动态优化病组成本标杆值,形成了确立标杆、对照标杆、达到标杆、优化标杆的闭环管理。自2023年3月实施基于病组成本标杆的绩效管理以来,医院的病例组合指数从3月的1.52增至9月的1.54;平均住院日从6.22 d降至5.90 d;月支付权重从18103增至18558;住院次均费用从16724元/例降至15278元/例,且以药品、耗材费用下降为主,其中药品费占比从27.45%降至26.32%,耗材费占比从28.75%降至26.85%,医疗服务收入占比从24.64%增至26.08%;低倍率病例占比从9.09%降至8.24%;医保支付率从99.3%增至107.0%;医生工作满意度从2022年的70.00%提升至2023年的76.77%,可为其他医院的绩效管理实践提供参考。Taking the reform of payment methods based on diagnosis related groups as an opportunity,implementing performance management based on disease groups is an important lever to promote the improvement of hospital diagnosis and treatment level and high-quality development.In 2023,a tertiary comprehensive hospital introduced benchmarking management into performance management,using the average days of stay,drug costs,and consumables costs of the disease group as cost benchmark indicators.The cost benchmark values for each disease group was determined based on the big data of the disease group of the tertiary comprehensive hospital in the region and the clinical pathway management goals of the hospital.Through multidimensional and multi-level comparative analysis of the hospital′s historical values and regional big data distribution values of the benchmark indicators for each disease group,the cost benchmark values for each disease group was determined.The hospital has established a performance reward and punishment mechanism based on the benchmark value of disease group costs,and at the same time,established a performance management communication mechanism to promote relevant departments and medical groups to improve their management against the benchmark.In addition,with changes in the external environment and internal practices,the cost benchmark value of the disease group was dynamically optimized,forming a closed-loop management system that included establishing benchmarks,comparing benchmarks,achieving benchmarks,and optimizing benchmarks.Since the implementation of performance management based on disease group cost benchmarking in March 2023,the hospital′s case mix index has increased from 1.52 in March to 1.54 in September;The average days of stay decreased from 6.22 days to 5.90 days;The monthly payment weight has increased from 18103 to 18558;The average hospitalization cost has decreased from 16724 yuan/person to 15278 yuan/person,mainly due to the decrease in drug and consumables costs.The proportion of

关 键 词：医院 公立 疾病诊断相关分组 绩效管理 标杆管理 病组成本 

分 类 号：R197.322[医药卫生—卫生事业管理]