陕西省榆林市DRGs付费试点运行情况分析

Analysis on the operation of DRGs pilots in Yulin city of Shaanxi province

目的分析陕西省榆林市新型农村合作医疗住院按DRGs付费改革试点运行情况。方法利用榆林市3家DRGs试点医院2017年1—7月的33306例出院病例资料，结合专家座谈、现场考核和病例抽查进行分析。结果截至2017年7月，DRG分组器运行稳定。各试点医院出院病例入组率均在99％左右，仅少数DRG组CV〉1。3家医院平均住院日有所下降，2家三级医院的次均住院费用增长率有所下降。但也存在着DRGs相关配套制度不完善、临床路径覆盖率较低、监督考核工作滞后、病案管理质量参差不齐等问题。结论榆林市DRGs付费试点运行平稳，取得初步成效。建议进一步健全试点医院DRGs相关配套制度，加强临床路径推广与应用，完善DRGs考核方案，加强病案编码人员培训。

Objective To analyze the operation of the diagnosis-related groups （DRGs） pilots for inpatients in the new rural cooperative medical system in Yulin city of Shaanxi province. Methods The medical records of 33 306 inpatients discharged from the 3 pilot hospitals between January and July in 2017 were analyzed, aided by expert discussions, on-site assessment and medical records examinations. Results By the end of July 2017, the DRGs grouping tool had been running stably. The DRGs enrollment rates of discharged inpatients were all up to 99% in the 3 pilot hospitals. The coefficient of variation （CV） was higher than 1 only in a few DRGs. The average length of stay and the average hospitalization expenses growth rate were both found declined. However, there also exist problems in the pilots, namely incomplete regulations for DRGs, low clinical path coverage rate, hysteretic supervision and assessment, uneven quality of medical records management and so on. Conclusions The pilots operated smoothly as evidenced in their initial success. Yet the following recommendations were raised for the improvements： To strengthen the organization and leadership to improve the DRGs related supporting system in pilot hospitals; To strengthen the promotion and application of clinical paths for standardization of the medical service process ; To improve the DRGs assessment program and establish DRGs operation monitoring and tracking analysis system; To strengthen the training of medical record coding staff to improve continuously the quality of medical records.