FOCUS-PDCA循环法在按病种付费管理中的应用效果  

Application effect of FOCUS-PDCA cycle method in diagnosis related groups management

作　　者：吕随治 林娟 彭晨珊 秦丽曼 吴佳琳 许赛华 LYU Suizhi;LIN Juan;PENG Chenshan;QIN Liman;WU Jialin;XU Saihua(Medical Insurance Office,Children's Specialty Hospital Area,Fuzhou First General Hospital,Fuzhou Children's Hospital,Fujian Province,Fuzhou 350005,China)

机构地区：[1]福州市第一总医院儿童专科院区,福建省福州儿童医院医保办,福建福州350005

出　　处：《中国当代医药》2025年第1期127-132,共6页China Modern Medicine

基　　金：福建省福州市“十四五”临床专科培强培优培育建设项目(20220101)。

摘　　要：目的探讨FOCUS-PDCA循环法在按病种付费管理中的应用效果。方法采用FOCUS-PDCA循环法对按病种付费进行干预,将2021年7月至2022年3月的14652例住院患者作为对照组,其中支气管肺炎病种1032例,将2022年4月至12月的14225例住院患者设为试验组,其中支气管肺炎病种1160例,分析对比FOCUS-PDCA实施前后的按病种付费的执行情况,重点评价病种支气管肺炎的执行率、次均费用、住院天数以及费用结构变化。结果试验组的按病种出院人次占比高于对照组,差异有统计学意义(P<0.05)。试验组的重点病种支气管肺炎纳入率高于对照组,次均费用低于对照组,药品费用低于对照组,差异有统计学意义(P<0.05)。结论FOCUS-PDCA循环管理能够有效促进按病种付费改革进展,有利于构建医保精细化管理模式,以此适应多元付费方式改革政策。Objective To explore the application effect of FOCUS-PDCA cycle method in diagnosis related groups management.Methods FOCUS-PDCA cycle method was adopted to intervene on pay by disease.A total of 14652 hospitalized patients from July 2021 to March 2022 were selected as the control group,including 1032 patients with bronchial pneumonia,and 14225 hospitalized patients from April 2022 to December 2022 were selected as the experimental group,including 1160 patients of bronchial pneumonia were analyzed.Implementation of diagnosis related groups were compared before and after the of FOCUS-PDCA,and the implementation rate of bronchopneumonia,the average cost per case,hospital stay and the change of the cost structure were evaluated.Results The proportion of patients discharged from hospital in experimental group was higher than that in control group,the difference was statistically significant(P<0.05).The inclusion rate of key diseases bronchopneumonia in the experimental group was higher than that in the control group,the average cost of time and the drug cost were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion The FOCUS-PDCA cycle management can effectively promote the progress of the reform of diagnosis related groups,and is conducive to the construction of the fine management model of medical insurance,so as to adapt to the reform policy of multiple payment methods.

关 键 词：FOCUS-PDCA循环法 按病种付费 支气管肺炎 精细化管理 

分 类 号：R197.323[医药卫生—卫生事业管理]