基于疾病诊断分组的医院人力资源配置公平性与服务能力的初步研究

Research on the equity and service capability of human resources allocation in departments of medical institutions based on diagnosis related groups

目的:分析基于疾病诊断分组(DRG)的医院科室间人力资源配置的公平性和服务能力。方法:采用回顾性研究的方法,从“住院病案”和“北京地区住院医疗服务绩效评价平台”收集2017—2019年首都医科大学附属北京胸科医院主要科室(结核科、肿瘤科、胸外科)住院服务量、DRG权重和医师数等DRG相关数据,借助卫生资源集聚度(≥1表明卫生人力资源公平性较高,人力资源相对充足)、集中指数(“正值”表示医师人力资源分布在服务量高的科室)、承载力系数(>1说明医疗机构处于超负荷工作、服务能力较强)和人均服务量等DRG指标评价科室间医师人力资源配置的公平性与服务能力。结果:2017—2019年,结核科、肿瘤科和胸外科的住院服务量依次为12505、16831、12137例次,总权重依次为14690.60、13904.75、14638.01,医师工作人月数依次为1039.5、1219.8和892.0人月。从住院服务量看,结核科医师人力资源集聚度>1;从DRG权重角度看,肿瘤科医师人力资源集聚度>1。三类科室集中指数从两个维度分析均<0。结核科人均服务住院量为144.36例次,略低于肿瘤科(165.58例次)和胸外科(163.28例次);而肿瘤科人均服务DRG权重(136.79)最低,结核科(169.59)次之,胸外科最高(196.92)。结论:以住院服务量和DRG权重两个维度得出的人力资源配置分析结果差异明显,受科室收治患者DRG权重影响明显。根据DRG付费原则,可通过提升患者周转效率和控制不合理费用支出来提高患者权重较小科室的人力资源配置效率。

Objective:To analyze the fairness and service capacity of human resources allocation among hospital departments based on diagnosis related groups(DRG).Methods:The DRG-related data such as service amount and DRG weight of the main departments(tuberculosis department,oncology department,thoracic surgery department)of Beijing Chest Hospital Affiliated to Capital Medical University from 2017 to 2019 were collected from“Hospital Inpatient Medical Records”and“Beijing Regional Inpatient Medical Service Performance Evaluation Platform”.A retrospective study method was used to evaluate the fairness and service capacity of inter-departmental physician human resource allocation by using indicators such as health resources agglomeration degree(≥1 indicates that the fairness of health human resources is relatively high and human resources are relatively sufficient),concentration index(“positive value”indicates physician manpower DRG indicators such as resources are distributed in departments with high service amount),carrying capacity coefficient(>1 means that medical institutions are overloaded and have strong service capabilities).Results:From 2017 to 2019,the inpatient service amount of tuberculosis department,oncology department and thoracic surgery department were 12505,16831 and 12137,respectively,and the total weights were 14690.60,13904.75 and 14638.01,respectively.The number of physician person-month were 1039.5,1219.8,and 892.0,respectively.According to the service amount,the concentration of human resources of tuberculosis physicians was>1;from the perspective of DRG weight,the concentration of human resources of oncologists was>1.The concentration index of the three types of departments was less than 0 from the analysis of two dimensions.The number of hospitalizations per capita in the tuberculosis department was 144.36 cases,which was slightly lower than that in the oncology department(165.58 cases),thoracic surgery department(163.28 cases).The per capita DRG weight of oncology department was the lowest(136.79),followed by tuberculosis department(169.59),and thoracic surgery department was the highest(196.92).Conclusion:The results of human resource allocation analysis based on the two dimensions of inpatient service amount and DRG weight were significantly different,and the DRG weight of patients admitted by the department was significantly affected.According to the DRG payment principle,the efficiency of human resource allocation in departments with less patient weight could be improved by improving patient turnover efficiency and controlling unreasonable expenses.