DRGs在我国医疗质量管理中的应用现状

The application status of DRGs in medical quality management in China

疾病诊断相关分组(DRGs)实质是“病例组合”的一种,是按照临床过程同质资源消耗相近的原则,将不同病例分门别类的一种组合方法,最初应用于医疗保险支付,经过不断发展,逐渐运用于医院之间评估、医院内部质量控制、成本管理等方面。DRGs作为风险调整工具,具有客观、科学、全面性,相比传统的绩效评价更科学更客观,随着DRGs时代的来临,越来越多地被运用于医疗质量的管理中,并取得了良好的效果。本文从Pubmed网站、中国知网、万方医学网等查阅了2014—2021年相关文献约100篇,综述了DRGs进入我国的背景、在医疗质量管理方面的应用趋势及在医疗质量管理中的研究现状,以期能充分利用DRGs的相关指标数据,客观科学的对医院医疗质量进行评价,为完善医院医疗质量管理体系,改善医疗质量提供一定的理论支持。

Diagnosis related groups(DRGs)are essentially a kind of"case mix".They are a combination method that classifies different cases according to the similar consumption of homogeneous resources in the clinical process.They were initially applied to medical insurance payments.After continuous development,they have been gradually applied to inter-hospital evaluation,hospital internal quality control,cost management,and other aspects.As a risk adjustment tool,DRGs are objective,scientific,and comprehensive.Compared with traditional performance evaluations,DRGs are more scientific and objective.With the advent of the DRGs era,they are increasingly used to manage medical quality and have achieved good results.This article reviewed about 100 relevant documents from the Pubmed website,China Knowledge Network,and Wanfang Medical Network from 2014 to 2021,and reviewed the background of DRGs entering China,the application trend in medical quality management,and research status in medical quality management,in order to make full use of the relevant index data of DRGs,objectively and scientifically evaluate the hospital′s medical quality,and provide certain theoretical support for improving the hospital′s medical quality management system and improving the medical quality.