摘要
目的 探讨总额控制下疾病诊断相关分组(DRG)支付改革对神经外科医疗服务能力的影响。方法 通过采集DRG试点城市四川省攀枝花市某三级甲等医院神经外科2018—2020年DRG数据,从能力、效率、费用等维度分析改革影响。同时,利用中断时间序列分析(interrupted time series analysis,ITSA)法,将该院出台的绩效考核方案对神经外科进行干预的效果进行比较研究。结果 神经外科在DRG支付下医疗服务能力缓慢下降:病例组合指数(CMI)呈缓慢下降趋势(斜率为-0.022 0);医疗服务效率缓慢下降:时间消耗指数呈上升趋势(斜率为0.013 5);医疗费用消耗缓慢上升:费用消耗指数呈上升趋势(斜率为0.011 3)。从ITSA结果来看,CMI在干预后明显上升,费用消耗指数在干预后明显上升。结论 神经外科在总额控制下的DRG支付改革中,医疗服务能力和效率都有所下降,医疗费用消耗有所增加。但该院出台的绩效考核方案对神经外科在评价指标上的干预有效,表明将绩效考核与DRG支付方式改革结合能取得较好的效果。
Objective To explore the impact of a comprehensive evaluation of DRG payment reform in neurosurgery under total amount control. Methods By collecting DRG grouping data of the department of neurosurgery in a tertiary first-class hospital in Panzhihua City,Sichuan Province,a DRG pilot city during 2018—2020,the impact of the reform was analyzed from the dimensions of medical service capacity,efficiency,and cost. Also,the effect of the hospital’s performance appraisal program on neurosurgery intervention was compared by using the ITSA method. Results Neurosurgery’s ability to provide medical services under DRG payments slowly declined: CMI(slope-0.022 0) showed a slow downward trend;medical service efficiency slowly decreased:the time consumption index showed an upward trend(slope of 0.013 5);and medical cost consumption slowly increased:the cost consumption index showed an upward trend(slope of 0.011 3). From the results of the ITSA analysis,the CMI increased significantly after the intervention;the cost consumption index increased significantly after the intervention.Conclusion In the DRG payment reform under the three-year total control of neurosurgery,the medical service capacity and operational efficiency have decreased,and the consumption of medical expenses has increased. However,the performance appraisal plan introduced by the hospital is effective in the intervention of neurosurgery in the evaluation indicators, indicating that the combination of performance appraisal and DRG payment method reform can achieve better results.
作者
刘可心
程永忠
Liu Kexin;Cheng Yongzhong(Panzhihua Central Hospital,Panzhihua,Sichuan,617067,China;不详)
出处
《中国医院管理》
北大核心
2023年第2期25-28,共4页
Chinese Hospital Management
基金
攀枝花市科学技术局市级指导性科技计划项目(第二批)(2020ZD-S-5)。
