基于按DRG付费的医疗服务监管指标体系构建

Construction of Medical Service Supervision Index System Based on DRG Payment

目的构建适配DRG付费的医疗服务监管指标体系,为DRG付费下的医院医疗服务监管提供依据。方法在初步查阅文献、专家小组讨论形成的指标体系的基础上,采用德尔菲专家咨询方法,通过两轮专家咨询确定医疗服务监管指标体系;运用层次分析法确定指标权重。结果构建了多层次的医疗服务监管评价体系,共包含3项一级指标、8项二级指标和31项三级指标。一级指标中,过程指标和结果指标权重相对较高;二级指标中服务能力和诊疗行为权重相对较高;三级指标中诊断填写准确率和30天再入院率权重较高。结论专家咨询结果具有可靠性,所构建的指标能多角度、多方面地对DRG付费下的医疗服务监管有导向作用。

Objective To construct a medical service index system suitable for DRG payment,and to provide a basis for further hospital medical service supervision under DRG payment. Methods Based on the index system formed by preliminary literature review and expert group discussion,the Delphi expert consultation method was adopted to determine the index system of medical service supervision through two rounds of expert consultation. Analytic hierarchy process was used to determine the index weight. Results A multi-level evaluation system was established,including 3 first-level indicators,8 secondary indicators and 31 tertiary indicators. In the first level index,the weight of process and result indicators is relatively higher. The weight of service ability and diagnosis and treatment behavior is relatively higher in the secondary indicators. Diagnostic accuracy and 30-day readmission rate have higher weights in tertiary indicators. Conclusion The results of the expert consultation are reliable,and the constructed indicators can reflect from multiple angles and aspects,and have a guiding effect on the medical service regulation under DRG payment.