DRG改革背景下某三甲医院肿瘤科室重点指标分析及政策研究  

Analysis and Policy Study of Key Indicators in Oncology Departments of a Tertiary Hospital under the Background of DRG Reform

作　　者：张玉洁 丁菡荣 李民浩 张春玲 张进 Zhang Yujie;Ding Hanrong;Li Minghao;Zhang Chunling;Zhang Jin(Audit Department,Qingdao Central Hospital of Rehabilitation University,Qingdao,Shandong,266042,China)

机构地区：[1]康复大学青岛中心医院审计科,山东青岛266042

出　　处：《青岛医药卫生》2024年第5期356-363,共8页Qingdao Medical Journal

基　　金：青岛市医院协会资助(QYGL20230017)。

摘　　要：目的 回顾性分析医院A肿瘤相关科室2021~2023年DRG指标的变迁,结合医院实施的政策,探究指标变化的原因及影响指标的因素。方法 使用万天DRG管理系统导出医院A的2021~2023年DRG相关历史数据分析DRG相关指标,并在各科室之间进行比较。结合医院推行的DRG相关政策及时间节点,探究指标变化的原因及影响因素。使用矩阵分析法将各科室分类,并分析各科室的病种特征。结果 2021~2023年,各科室CMI值、平均住院日、盈亏额均明显改善。医院通过直接考核以及改革日间诊疗模式显著改善了重点指标。病种结构是影响CMI的最主要的因素。平均住院日与CMI值大致呈正相关,但科室可通过优化诊疗模式缩短平均住院日。通过控制住院费用,各科室均实现模拟测算盈余。结论 本研究确认了医院不同政策对重点指标的影响,并提出了进一步改善重点指标的方法。本研究可为DRG改革中各公立医院医院管理、政策制定提供参考,也为肿瘤学科高质量发展提供经验与依据。此外,本研究认为DRG改革改善了医疗行为,有助于我国医疗卫生事业的发展。Objective To retrospectively analyze the changes in DRG indicators in the oncology-re-lated departments of Hospital A from 2021 to 2023,and to explore the reasons for these changes and factors influencing the indicators in conjunction with the policies implemented by the hospi-tal.Methods The DRG-related historical data of Hospital A from 2021 to 2023 were exported u-sing the Wantian DRG management system to analyze DRG-related indicators and compare them across various departments.The reasons and influencing factors for the changes in indicators were investigated in conjunction with the DRG-related policies and timelines implemented by the hospital.Matrix analysis was used to categorize departments and analyze the disease characteris-tics of each.Results From 2021 to 2023,there was a significant improvement in the CMI value,average length of stay,and profit and loss amount the each department.The hospital has signifi-cantly improved key indicators through direct evaluation and reform of day care mode.The dis-ease structure was the most significant factor affecting CMI.There is a positive correlation be-tween the average length of stay and CMI value,but departments can shorten the average length of stay by optimizing the treatment model.By controlling inpatient costs,each department achieved a simulated surplus.Conclusion This study confirmed the impact of different hospital policies on key indicators and proposed methods for further improving these indicators.The stud-y can provide a reference for hospital management and policy formulation in public hospitals dur-ing DRG reform and also offers experience and evidence for the high-quality development of on-cology disciplines.Additionally,the study suggests that DRG reform has improved medical be-havior and contributed to the development of China's healthcare industry.

关 键 词：医保改革 医院管理 DRG CMI 平均住院日 

分 类 号：R-01[医药卫生]