北京市医药分开综合改革对门诊CT服务利用情况影响的研究

Impacts of the clinics-pharmacy separation reform on outpatient CT utilization in Beijing

目的分析北京市医药分开综合改革对门诊电子计算机断层扫描(CT)检查量的影响,为医院大型影像设备的合理使用、精细化管理和后续医疗服务价格调整提供政策建议。方法采集北京市某三级公立医院2015年1月1日至2019年4月30日的CT检查量数据,利用单组和多组间断时间序列分析方法进行分析,并进行定性访谈。结果间断时间序列回归结果显示改革后该院门诊每百诊疗人次CT检查人次的即刻变化水平增加0.216人次(P<0.001),变化趋势(斜率)增加0.012人次/月(P<0.001),改革前后城镇职工基本医疗保险和城镇居民基本医疗保险的门诊每百诊疗人次CT检查人次的斜率改变量差异无统计学意义(P=0.504)。结论医药分开改革使得该院门诊CT检查利用水平整体增加,但对城镇职工基本医疗保险和城镇居民基本医疗保险两类参保人群的门诊CT检查利用水平长期趋势及其存在的差异并无显著影响。定性访谈结果提示需要关注相关从业人员超负荷工作状态,并警惕大型仪器设备过度利用行为。

Objective To analyze the impacts of the clinics-pharmacy separation reform on outpatient CT utilization and provide policy recommendations for the rational use,refined management and subsequent price adjustment for large-scale imaging equipments.Methods The number of outpatient CT examinations of a tertiary public hospital in Beijing from January 1st,2015 to April 30th,2019 was collected.Data were analyzed using single-and multi-group interrupted time series analysis model(ITS),along with qualitative interviews.Results The number of CT examinations increased by 0.216 per 100 visits after the reform(P<0.001).The trend of changes(slope)in the number of CT examinations increased by 0.012 person-times/month(P<0.001).There were no statistically significant differences in the slope change of CT examinations between patients under Urban Employee Basic Medical Insurance and those under Urban Resident Basic Medical Insurance(P=0.504),Conclusions The reform has significantly increased the utilization of outpatient CT examinations.However,the impacts of the reform may be similar among patients covered by different insurance systems.The qualitative interviews imply it as necessary to pay attention to the overworking status of relevant practitioners and be alert to the excessive use of large-scale imaging equipments.