DRGs视角下某县级医院骨科医疗服务绩效评价

Evaluationon Medical Service Performance of the Orthopaedic Department in a County Level Hospital Using Diagnosis Related Groups(DRGs)Tool

目的利用疾病诊断相关分组(diagnosis related groups,DRGs)对骨科专科的医疗服务绩效进行分析,为持续改进医疗服务水平、加强专科建设提供实证依据。方法收集2017—2019年某县级医院骨科四个病区的住院病案首页数据,运用综合指数法进行绩效评价,并分析病种结构的差异。结果2017年和2018年四个病区的综合绩效排名依次为C、B、A和D病区,2019年综合排名依次为B、C、A和D病区;三年间A、B和C病区的综合指数值呈上升趋势,D病区呈下降趋势;根据相对权重(relative weight,RW)值,A病区在各层次中占比相对均衡,B、C病区在RW≤1和RW>2层次中占比均较高,D病区在RW≤1层次中占比最高,各病区的优势及劣势病种各有侧重。结论DRGs真正展现了临床科室的医疗质量、技术水平、服务效率和效益;通过绩效考评,可以明确医院的优势学科和优势病种,帮助医院专科科学均衡发展。

Objective Using Diagnosis Related Groups(DRGs)tool to evaluate the medical service performance of the orthopaedic department,to provide an empirical basis for continuously improving the medical service and strengthening the discipline construction.Methods Data of the front pages of hospitalized patients from 2017 to 2019 were collected in 4 wards of orthopaedic department of a county-level hospital.The comprehensive index me-thod was used to evaluate performance and the differences in disease structure were analysed.Results The comprehensive rankings of 4 wards were Ward C,B,A and D both in 2017 and 2018.Then turn into Ward B,C,A and D in 2019.An uptrend was observed in the composite index value of Ward A,B and C in the three years.While a downtrend was showed in Ward D.The distribution of discharges in Ward A was relatively balanced according to the Relative Weight(RW)value.More discharges in Ward B and C were distributed in the level of RW≤1 and RW>2.Most discharges in Ward D were distributed in the level of RW≤1.The dominant and inferior diseases in each ward were different.Conclusion DRGs was used to show the real medical quality,the diagnostic techniques,the service efficiency and effectiveness.The advanced discipline and disease of the hospital could be explicit and needed to develop in a scientific and balanced way based on the evaluation of performance.