病例组合付费下临床决策行为模型演进  

Evolution of clinical decision-making behavior models under case-mix payment

作　　者：尹世全 张勇 YIN Shiquan;ZHANG Yong(National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100021,PRC)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院,北京市100021

出　　处：《中国医院》2024年第12期80-83,共4页Chinese Hospitals

基　　金：中国医学科学院肿瘤医院管理研究课题(LC2022D01)。

摘　　要：互联网信息时代使得临床决策面临新环境,医疗专业性权威受到挑战,医疗纠纷增多促使医生实施防御性医疗,均挤占临床时间。国家从2022年开始推动DRG/DIP支付方式改革。这一系列改变导致临床决策行为产生一系列变迁。DRG和DIP均属于病例组合付费方式。基于国内外研究,作者从显性、中性和隐性3个层次对不同的临床决策行为相关维度进行初步分析,在不同假定前提下归纳出三级进阶演进模型。在此基础上,提出临床决策行为依然保持服务人民健康、回归医疗本质和患者获益的不变主题。In the age of the internet information,clinical decision-making is influenced by a new environment where the traditional authority of medical expertise is challenged,more disputes leading to more defensive medicine practices and reduced clinical time.Since 2022,China has promoted reforms in payment models such as DRG(Diagnosis-Related Groups)and DIP(Diagnosis-Intervention Packet).These changes have led to shifts in clinical decision-making behaviors.Both DRG and DIP belong to case-mix payment methods.Based on domestic and international studies,the authors conducts an analysis of clinical decision-making behavior across explicit,neutral,and implicit dimensions and generalize a three-level progressive model under various assumptions.The study suggests that clinical decisionmaking should continue to prioritize public health,adhere to the core essence of medical care,and focus on patient benefit.

关 键 词：疾病诊断相关分组 病种分值付费 病例组合付费 临床决策行为 

分 类 号：R197.3[医药卫生—卫生事业管理]