基于疾病诊断相关分组分析日间手术精细化管理的应用效果  

Application effect of refined management in day surgery based on diagnosis-related groups

作　　者：王丹 谢蘋 郑楚发[1] 李丽璇[1] 洪春燕[2] 姚静琳 林浩[1] 潘泽群[1] WANG Dan;XIE Ping;ZHENG Chufa;LI Lixuan;HONG Chunyan;YAO Jinglin;LIN Hao;PAN Zequn(Medical Affairs Department,Shantou Central Hospital,Shantou,Guangdong 515041,P.R.China;Operations Management Office,Shantou Central Hospital,Shantou,Guangdong 515041,P.R.China)

机构地区：[1]汕头市中心医院医务科,广东汕头515041 [2]汕头市中心医院运营管理办公室,广东汕头515041

出　　处：《华西医学》2024年第12期1867-1873,共7页West China Medical Journal

基　　金：汕头市科技计划医疗卫生类别项目(221115216493058)。

摘　　要：目的评价疾病诊断相关分组(diagnosis-related groups,DRG)精细化管理效果,总结精细化管理经验,并对存在问题提出改正措施。方法选择2021年4月—2023年3月在汕头市中心医院采用日间手术服务模式患者为研究对象。根据管理模式将纳入患者分为常规管理组(2021年4月—2022年3月)和精细化管理组(2022年4月—2023年3月)。比较两组患者一般情况、医疗质量、患者满意度的指标。并按照DRG组分层,分析两组的住院时间、住院总费用、术后并发症等医疗指标的差异。结果共纳入患者4584例,其中常规管理组1686例,精细化管理组2898例。两组在患者来源、手术等级、省权重系数比较差异均有统计学意义(P<0.05);但在性别、年龄、离院方式比较,差异均无统计学意义(P>0.05)。精细化管理组在手术流程、术前指导、服务态度、护理技能的满意度均高于常规管理组(P<0.05)。共纳入≥100例患者的DRG组数4个,精细化管理组2215例,常规管理组1460例。其中,CB39组(晶体手术)1496例,GE10组(腹股沟及腹疝手术,年龄<17岁)336例,JB29组(乳腺非恶性肿瘤乳腺部分切除术)1412例,NE19组(外阴、阴道、宫颈手术)431例。其中,在CB39组(晶体手术)、GE10组(腹股沟及腹疝手术,年龄<17岁)、JB29组(乳腺非恶性肿瘤乳腺部分切除术)、NE19组(外阴、阴道、宫颈手术)中,精细化管理组的住院总费用、住院时间均低于常规管理组(P<0.05)。在CB39组(晶体手术)、NE19组(外阴、阴道、宫颈手术)中,精细化管理组的术后并发症发生情况低于常规管理组(P<0.05);在GE10组(腹股沟及腹疝手术,年龄<17岁)中,精细化管理组的疼痛、切口出血发生情况低于常规管理组(P<0.05);在JB29组(乳腺非恶性肿瘤乳腺部分切除术)中,精细化管理组的切口感染情况低于常规管理组(P<0.05)。两组其他指标比较,差异均无统计学意义(P>0.05)。结论对日间手术开展精细化管�Objective To evaluate the refined management effect of diagnosis related groups(DRG),summarize the experience of refined management,and put forward corrective measures for existing problems.Methods Patients who underwent day surgery services at Shantou Central Hospital between April 2021 and March 2023 were selected.According to the management mode,patients will be divided into a conventional management group(April 2021 to March 2022)and a refined management group(April 2022 to March 2023).The general condition,medical quality,and patient satisfaction indicators of two groups of patients were compared.And according to the DRG group stratification,the differences in medical indexes such as length of hospital stay,total hospitalization expenses,and postoperative complications between the two groups were analyzed.Results A total of 4584 patients were included,including 1686 in the conventional management group and 2898 in the refined management group.There were statistically significant differences between the two groups in terms of patient source,surgical grade,and provincial weight coefficient(P<0.05).However,there was no statistically significant difference in gender,age,and discharge method(P>0.05).The satisfaction of the refined management group with surgical procedures,preoperative guidance,service attitude,and nursing skills was higher than that of the conventional management group(P<0.05).A total of 4 DRG groups(≥100 patients)were included,with 2215 patients in the refined management group and 1460 patients in the conventional management group.Among them,there were 1496 cases in the group CB39(cataract surgery),336 cases in the group GE10(inguinal and abdominal hernia surgery,age<17 years old),1412 cases in the group JB29(partial mastectomy for non-malignant breast tumors),and 431 cases in the group NE19(vulvar,vaginal,and cervical surgeries).Among them,in the group CB39(cataract surgery),group GE10(inguinal and abdominal hernia surgery,age<17 years old),group JB29(partial mastectomy for non-malignant brea

关 键 词：日间手术 精细化管理 医疗质量 绩效考核 工作流程 

分 类 号：R472.3[医药卫生—护理学]