基于RBRVS的绩效考核模式优化:“价值医疗”中的管理探索

Based on the optimization application of RBRVS in performance appraisal

目的通过评价外科医师手术操作能力,进一步优化基于以资源为基础的相对价值比率(RBRVS)的绩效考核体系。方法回顾性收集四川大学华西医院2019年1月1日至12月31日疾病诊断相关分组(DRG)组名为腹腔镜胆囊切除术不伴胆总管探查、国际疾病分类ICD-9-CM-3中编码为51.230 0的全部病例,通过文献检索、专家访谈等方法,选取与外科医师手术操作能力相关的关键指标,采用主成分分析法,构建外科医师手术操作能力的评价模型。结果通过构建的外科医师手术操作能力评价模型,进一步修正每例手术操作RBRVS系数,经调整后不同医师的RBRVS系数具有差异性。结论构建的外科医师手术操作能力评价模型具有可操作性,能体现不同医师在同一医疗服务项目处理上的水平和能力差异,促进医院绩效管理精细化发展。

Objective To further optimize the performance appraisal system based on resource based relative value scale(RBRVS) by evaluating the surgical operation ability of surgeons. Methods From January 1,2019 to December 31, 2019, all patients in diagnosis related groups(DRG)group named laparoscopic cholecystotomy without common bile duct exploration and code 51.230 0 in International Classification of Diseases ICD-9-CM-3 were retrospectively collected. The key indicators related to surgical operation ability of surgeons were selected through literature review and expert interviews, and the evaluation model of surgical operation ability of surgeons was established by principal component analysis. Results The RBRVS coefficients of each operation were further modified by the constructed evaluation model of surgeons’ surgical ability. After adjustment, the RBRVS coefficients of different surgeons were different. Conclusion The evaluation model of surgical operation ability of surgeons is operable, which can reflect the difference of different doctors’ level and ability in the treatment of the same medical service item,and promote the refined development of hospital performance management.