试论病例组合 DRGs与临床质量管理

Opinions on Casemix,DRGs and Clinical Quality Management

病例组合是通过一定原则对病人进行分类管理的一种工具。DRGs根据临床相似性、资源消耗相似性对急性住院病人进行分类,可用于住院筹资和补偿、住院资源配置和调整、住院预付制(即DRG-PPS)、绩效评价和比较研究等方面。各国DRG内部分组的粗细不一,各医院收治的疾病种类和病人的构成也存在一定的差异,DRG分组也应该根据情况。在开展支付制度改革的时候必须有质量监测、评价和控制措施相配套。DRG分组和支付标准的研究和建立是一个繁杂的系统工程,必须在国家层面上,统一开发,形成国家标准,统一实施。

Casemix is a tool of patient classifi cation management, acute inpatient patients, ambulatory patients. DRGs is an acute inpatient classification system which group patients into clinically meaningful and resource homogenous groups to describe the output of the hospital and could be used in activity - based funding, planning and evaluation programs, resource allocation and restructure, prospective payment system, clinical management, performance assessment as well as benchmarking. Groups within DRGs in different countries vary greatly, there is also great differences in the composition of patients admitted to hospitals and their diseases spectrum, therefore, the hospital to conduct clinical path should match the DRG group under certain circumstances. Quality monitoring, assessment and quality assurance measures should be accompanied by payment method reforms. Development of DRG grouping and PPS reform are complex systems and should be conducted under the leadership of the government.