DRGs在临床科室医疗服务绩效评价中的应用研究

Application of DRGs in Medical Service Performance Evaluation of Clinical Departments

目的通过对杭州市某三甲医院2016-2017年科室的DRGs相关指标进行分析,从而对临床科室医疗服务绩效能力进行评价,为医院精细化管理提供重要依据。方法本研究主要通过对医院的产出指标(DRG组数、DRGs总量、CMI、疑难病例数)和效率指标(时间指数和费用指数)进行科室横向和年度纵向比较分析,同时对各科室的DRGs组数与CMI值,时间指数和费用指数进行综合分析,进而对各科室的绩效水平做出评价。结果2017年医院大部分科室各项产出指标较2016年均有提高,但仍有部分科室DRG组数和CMI值较2016年下降,应结合科室特点,适当扩大收治病种的数量和提高病例疑难程度。部分科室住院时间和住院费用较全院平均水平高,绩效较差,科室应关注住院时间的缩短和住院费用的控制。结论DRGs作为临床科室绩效评价的工具具有科学性和可靠性,其评价结果有助于科室内部结构的优化,促进医疗质量的提升,同时DRGs绩效评价依赖病案首页信息的准确性和完整性。

Objective To evaluate medical service performance of the clinical department and provide an important basis for the refined management of the hospital by analyzing DRG-related indicators of the department of a level-A tertiary hospital in Hangzhou from 2016 to 2017.Methods A horizontal comparison through department and a vertical comparison of years were conducted on the hospital output index(DRG group number,total number of DRGs,CMI and case number of difficult diseases)and efficiency index(time index and cost index),and a comprehensive analysis of the DRGs group number,CMI value,time index and cost index was adopted to evaluate the medical service performance of each department.Results The output indicators of most departments of the hospital increased in 2017 compared with those in 2016,while the number of DRG groups and CMI values in some departments declined.The departments should expand the range of diseases and involve cases of more difficult diseases based on the situation.The duration of hospital stay and medical expenses in some departments exceeded the average level of the whole hospital.Such departments were supposed to solve these problems to demonstrate better performance.Conclusion Based on the accuracy and completeness of information on the home page of medical records,DRGs serve as a scientific and reliable tool in clinical department performance evaluation that promote the structural optimization within the department and the improvement of medical quality.