按疾病诊断相关分组付费下医院精细化管理关键技术研究  

Research Key Technologies of Fine Management in Hospitals Based on Disease Diagnosis Related Groups Payment

作　　者：陈璐 孙梦峣 张依彤 杨威 马雷 CHEN Lu;SUN Mengyao;ZHANG Yitong;YANG Wei;MA Lei(Dean's Office,Tianjin Cancer Hospital Airport Hospital,Tianjin 300308,China;Department of Medical Insurance,Tianjin Cancer Hospital Airport Hospital,Tianjin 300308,China;Medical Insurance Office,Tianjin Medical University Cancer Hospital,Tianjin 300060,China)

机构地区：[1]天津市肿瘤医院空港医院院长办公室,天津300308 [2]天津市肿瘤医院空港医院医疗保险部,天津300308 [3]天津医科大学肿瘤医院医疗保险办公室,天津300060

出　　处：《中国卫生标准管理》2024年第21期26-29,共4页China Health Standard Management

基　　金：天津医科大学2024年度医院管理创新研究项目(2024YG20)。

摘　　要：在“医疗、医保、医药”协调联动改革背景下,随着以按疾病诊断相关分组(diagnosis related groups,DRG)为主的医保支付方式改革的深入推进,促使医疗机构主动转变管理理念、持续提升精细化管理水平和建立科学的成本管理思路,进而实现高质量发展。为保证DRG付费制度在医疗机构落地实施,在深入分析DRG支付管理要求、实施细则以及结算模式的前提下,医院管理中需要解决的关键问题包括病案入组准确性、合理控制医疗费用、调整诊疗结构。文章结合医院管理实践,从医保DRG付费的制度设计、医院管理策略等方面进行分析与探讨。DRG付费下的医院管理策略重点应从多部门协调配合、医疗服务流程整合与再造、单病种费用标准化管理、强化病案首页能力建设等方面着力,并依托医院信息化建设实现管理闭环。研究结果为各级定点医疗机构应对DRG付费提供了管理建议。Under the reform of medical insurance payment methods mainly based on diagnosis related groups(DRG),hospitals should actively transform their management concepts and improve their level of refined management.Based on understanding the implementation plan and rules of DRG payment,key issues that needed to be solved in hospital management including accuracy of medical record enrollment,reasonable control of medical expenses,and adjustment of diagnosis and treatment structure.In order to ensure the smooth implementation of DRG payment system in medical institutions.This study combines hospital management practices to analyze and explore the system design of medical insurance DRG payment and hospital management strategies.The hospital management strategy should focus on coordinating and cooperating with multiple departments,integrating and reengineering medical service processes,standardizing single disease cost management,strengthening the capacity building of medical record front pages,and relying on hospital information construction to achieve a closedloop management.The research findings provide management recommendations for designated medical institutions at all levels to cope with DRG payments.

关 键 词：疾病诊断相关分组付费 医院管理 关键技术 诊疗路径 医疗成本 科学运营 

分 类 号：R197[医药卫生—卫生事业管理]