基于诊断相关组的北京地区部分医院主要疾病住院服务绩效评价

Performance evaluation of inpatients＇ medical service for major diseases in some Beijing municipal hospitals based on diagnosis-related groups

目的首次应用诊断相关组（diagnosis related groups，DRGs）对北京市属医院系统整体进行主要诊断类别（major diagnosti ccategory，MIX；）住院服务绩效综合评价，并就评价结果提出加强北京市属医院系统主要疾病诊疗能力建设和提高住院服务绩效等方面的建议。方法应用BJ-DRGs分组器软件对2012年至2014年北京市全部出院病例病案首页信息进行计算确定各DRG组权重，并以全市各DRG组权重为基础，对2012年至2014年市属医院系统和央属医院系统的有关指标数据进行比较和分析。结果北京市属医院系统整体50％MDC的诊疗难度、81．8％MDC的时间效率、77．3％MIX；的费用效率、54．5％MDC的综合能力等指标上均有改善，且有68．2％MDC在费用效率、59．1％MDC在时间效率等指标上好于央属医院系统，但72．7N的MDC在诊疗难度上低于央属医院系统，综合能力指数2个系统相比持平；另发现3年来北京地区主要三级医院覆盖的疾病种类增加不明显。MDC权重中贡献率较大的市属医院与国家临床重点专科建设项目承接医院高度吻合。结论基于DRGs的北京市属医院系统整体主要疾病住院服务绩效综合评价结果显示，北京市医院管理局通过加大政府投入、优化服务组织、实施绩效管理等措施，对改善市属医院系统整体住院服务绩效尤其是在减轻患者负担、提高服务效率等方面发挥了重要作用，但也提示要通过集团化建设与管理等措施不断提高市属医院系统的临床专科能力，提高IVIDC诊疗难度，回归三级医院职能。

Objective To use diagnosis related group （DRGs） for the first time in overall evaluation of inpatient service performance evaluation of major diagnostic category （MDC） for all the Beijing municipal hospitals, and recommend how to strengthen Beiiing municipal hospitals system in diagnosis and treatment ability of main diseases and improve inpateint service performance. Methods BJ-DRGs burster software was used to analyze the first page information of the medical records of cases discharged from all the Beijing municipal hospitals between 2012 and 2014 to determine the weight of each DRG, and based on such weight the related indicators of such hospitals and central hospitals in 2012, 2013, 2014 were compared and analyzed. Results Improvements were found in such indices as diagnosis and treatment difficulty of 50% MDC, time efficiency of 81.8% MDC, cost efficiency of 77. 3% MDC, and general capacity of 54. 5% MDC for all Beijing municipal hospitals. In addition, the municipal hospitals were found superior to the central hospitals in such indices as cost efficiency of 68. 2% MIDC, and time efficiency of 59. 1% MDC. On the other hand however, they were found inferior to the central hospitals in such indices as diagnosis and treatment difficulty of 72. 7% MDC, and the comprehensive ability index of the two systems were found equivalent. Another finding was that there was no obvious improvement of the coverage of disease types at major tertiary hospitals in Beijing for the past three years. Municipal hospitals of greater contribution of MDC weight were highly consistent with the hospitals assigned with national key projects of disciplinary developments. Conclusion The comprehensive evaluation results of inpatient service performance of main diseases at Beijing＇ s municipal hospitals based on DRGs system, showed that the Beijing＇s hospital authority had played an important role in improving inpatient service performance especially in reducing the burden of patients, improving the service efficiency through increasing government investment, optimizing service organization and implementation of performance management. But it also suggested that measures such as collectivize construction and management should be taken to improve municipal hospitals＇ linical specialty ability, improve the MDC diagnosis and treatment difficulty, and resume their functions of tertiary hospitals.