医保患视角下DRG实施效果评价指标体系构建研究  

Construction of DRG Implementation Effect Evaluation Index System from the Perspective of Hospital,Insurance and Patients

作　　者：冯旅帆 徐嘉婕 唐密 彭颖 金春林[1] Feng Lüfan;Xu Jiajie;Tang Mi(Shanghai Health and Health Development Research Center/Shanghai Institute of Medi-cal Science and Technology Information,Shanghai,200031,China;不详)

机构地区：[1]上海市卫生和健康发展研究中心·上海市医学科学技术情报研究所,上海200031 [2]中国福利会国际和平妇幼保健院·上海交通大学医学院附属国际和平妇幼保健院,上海200030

出　　处：《中国医院管理》2025年第3期72-77,共6页Chinese Hospital Management

摘　　要：目的从医保、医院和患者三方利益出发,构建疾病诊断相关分组(DRG)实施效果评价指标体系,为医保部门掌握DRG实际运行效果提供评价工具。方法通过文献查阅初步构建评价指标体系,然后采用德尔菲法进行两轮专家咨询,根据专家意见的集中程度和协调程度筛选并修改评价指标,构建最终的评价指标体系。结果两轮专家咨询的专家积极系数分别为73%和82%,专家权威系数均值为0.78。第二轮咨询中,评价指标重要性、数据可得性和敏感性的Kendell’s W系数分别为0.517、0.437和0.472(P<0.001)。最终构建的DRG实施效果评价指标体系包括3个一级指标、10个二级指标、29个三级指标。结论构建的DRG实施效果评价指标体系专家积极性较高,专家权威程度、协调程度和集中程度较好,可用于评价DRG试点地区医保基金的可持续性、医疗机构的服务产出和患者的参保权益。Objective To construct the evaluation index system of DRG implementation effect from the interests of medical insurance,hospitals and patients,and provide evaluation tools for medical insurance departments to grasp the actual operation effect of DRG.Methods The evaluation index system is constructed initially through literature review,and then Delphi method is used to conduct two rounds of expert consultation.According to the concentration degree and coordination degree of expert opinions,the index system is selected and modified,and the final evaluation index system is constructed.Results The positive coefficients of experts in the two rounds of expert consultation were 73%and 82%respectively,and the average authority coefficient of experts was 0.78.In the second round of consultation,the Kendell’s W coefficients of the importance,data availability and sensitivity of the evaluation index were 0.517,0.437 and 0.472 respectively(P<0.001).Finally,the evaluation index system of DRG implementation effect includes 3 first-level indicators,9 second-level indicators and 29 third-level indicators.Conclusion The evaluation index system of DRG implementation effect has high enthusiasm of experts,good authority,coordination and concentration of experts,which can be used to evaluate the sustainability of medical insurance fund,the service output of medical institutions and the rights and interests of patients in DRG pilot areas.

关 键 词：疾病诊断相关分组 实施效果 评价指标体系 

分 类 号：R197.3[医药卫生—卫生事业管理]