基于DRGs系统应用与推广对策探讨

Discussion on the Application and Promotion of DRGs System in our Hospital

目的探索基于我院DRGs系统应用过程中发现的问题,为DRGs的推广应用提供建设性意见。方法采用基于CN-DRGs分组方案(2014版)的DRGs住院医疗服务绩效评价平台系统对我院近4年出院病案首页进行回顾性分析。结果 DRG组数由2013年的590组上升至2016年的610组,总权重由2013年的49996上升至2016年的64079,病例技术指数CMI值由2013年的0.95上升至2016年的1.06,时间指数由2013年的1.18下降至2016年的1.03,费用指数由2013年的0.78上升至2016年的0.85,低风险死亡率由2013年的0.003%下降至2016年的0.002%。结论 1、纵向来看,总体上我院医疗服务产能逐年提升,医疗服务效率逐年提高,但与其他医院尚无可比性。2、首页数据质量和统一的ICD编码、分组方案与权重计算是影响DRGs评价系统的四个核心因素,需要政策层面予以统一规范,一定区域内的医院方可进行横向比较和评价。

Objective To explore the problems found in the application of DRGs system in our hospital, provide constructive suggestions for the popularization and application of DRGs. Methods The DRGs inpatient medical service performance evaluation platform based on CN-DRGs group plan（2014 Edition） was adopted to analyze retrospectively the front page of discharged medical records in our hospital during the past 4 years. Results DRG groups increased from 590 in 2013 to 610 in 2016, the total weight increased from 49996 in 2013 to 64079 in 2016, CMI increased from 0.95 in 2013 to 1.06 in 2016, the time index decreased from 1.18 in 2013 to 1.03 in 2016, cost index increased from 0.78 in 2013 to 0.85 in 2016, the mortality of low risk decreased from 0.003% in 2013 to 0.002% in 2016. Conclusion 1. From the longitudinal perspective, the overall medical service capacity and efficiency in our hospital increased year by year, however, with no comparability to other hospitals. 2, Quality of data and unified ICD code, grouping scheme and weight calculation are the four core elements impacting DRGs evaluation system, which need to be standardized on policy level, then the hospitals in a certain area can be compared and evaluated horizontally.