应用间断时间序列分析评价医院DRG绩效改革效果

Application of Interrupted Time Series Analysis in Evaluating Effect of DRG Performance Reform of Hospital

目的 评估中山市某综合医院实行DRG专项绩效管理改革对综合医院相关绩效的影响,为实行DIP医保支付方式改革提供参考,以帮助同级医疗机构在医保改革进程中实现平稳过渡。方法 基于目标医院2017年6月至2021年5月四年的DRG绩效数据,将2019年6月前设定为改革前,之后设定为改革后,运用间断时间序列分析及分段回归模型进行拟合,分析改革前后的绩效指标变化趋势。结果 改革后医院病种总权重、CMI值、高RW值的病例数显著增加,时间消耗指数的趋势从上升变为下降,医疗质量、出院人次、平均住院天数、手术次数等指标未受明显影响。结论 DRG专项绩效改革对目标医院的病种结构优化起到积极作用,有利于促进大型综合医院落实救治疑难及急危重症患者的公益性定位,且此改革方案具有较好的可复制性,适用于大部分同级别综合医院。

Objective To evaluate the effect of DRG performance reform on the performance in a general hospital,so as to provide reference for Diagnosis-Intervention Packet(DIP) reform and to help other medical institutions adapt to the reform.Methods The DRG data of the hospital from June 2017 to May 2021 was used in the analysis,and June 2019 was when the reform took place.Interrupted time series analysis(ITSA) and piecewise regression model were used to fit the data to explore the changing trend of indicators before and after the reform.Results The results showed that the total weight of diseases,CMI value and the proportion of cases with high RW value increased significantly after the reform,and time consumption index changed from rising to declining.The indexes of medical quality,number of discharged patients,average length of stay and number of surgeries did not change significantly.Conclusion The DRG performance reform plays a positive role in optimizing the disease structure,helps the large general hospitals to reinforce the public welfare positioning,and is easily replicated in most general hospitals at the same level.