DRG视角下新冠肺炎疫情对医疗服务的影响——以上海市某二级综合医院为例

Study on the Impact of COVID-19 Epidemic on Medical Services from the Perspective of Diagnosis Related Groups:Take A Certain Secondary General Hospital in Shanghai as An Example

目的:基于DRG视角研究新型冠状病毒肺炎疫情对医疗服务的影响。方法:以上海市某二级综合医院为例,采用2016版CN-DRGs分组系统对2019、2020年医院住院病例进行分组,从产能、效率和安全3个维度对医院2019、2020年医疗服务状况进行比较。结果:2019年医院住院总病例数13101例,入组总病例数13037例,总入组率99.78%。2020年住院总病例数9731例,入组总病例数9709例,总入组率99.77%。2019—2020年医院DRG组数从435组下降到426组,总权重从11825.35下降到8164.54,CMI值由0.91下降到0.85,时间消耗指数从0.93上升到1,费用消耗指数从0.87上升到0.93,中低风险死亡率从2.6上升到6.62,两年低风险死亡率均为0。与2019年相比,2020年医院多数科室及专业组产能下降,效率也有所下降,但医疗安全可控。结论:DRG视角下新型冠状病毒肺炎疫情对医院医疗服务产生了较大的影响,虽然存在着客观因素,但医院科室内部加强管理,发挥主观能动性,在产能、效率和安全方面仍可以取得较好的成绩。面对疫情管控的常态化,如何借助DRG管理工具在实现精细化管理的同时有效地促进学科发展,是医院下一步应该认真研究的课题。

OBJECTIVE The impact of COVID-19 epidemic on medical services from the perspective of DRGs was analyzed and evaluated.METHODS Taking a secondary general hospital in Shanghai as an example,the“2016 CN-DRGs grouping system”was used to group hospitalized cases in 2019 and 2020,and the medical service status of hospitals in 2019 and 2020 was compared from three dimensions of production capacity,efficiency and safety.RESULTS In 2019,the total number of hospitalized cases was 13101,and the total number of enrolled cases was 13037,with a total enrollment rate of 99.78%.In 2020,the total number of hospitalized cases was 9731,and the total number of enrolled cases was 9709,with a total enrollment rate of 99.77%.From 2019 to 2020,the number of DRGs groups in hospitals decreased from 435 to 426,the total weight of the group decreased from 11825.35 to 8164.54,and the CMI value decreased from 0.91 to 0.85.The time consumption index increased from 0.93 to 1,and the expense consumption index increased from 0.87 to 0.93.The low risk mortality rate was 0,and the low and medium risk mortality rate increased from 2.6 to 6.62.Productivity and efficiency of most departments and professional groups showed a downward trend,but the medical safety was controllable.CONCLUSION From the perspective of DRGs,the epidemic situation of COVID-19 has a great impact on medical services.Although there are objective factors,the department can still achieve good results in terms of capacity,efficiency and safety by strengthening internal management and exertion of initiative.In the face of the normalization of epidemic control,how to effectively promote the development of the discipline while realizing fine management with the help of DRGs management tools is still a topic that should be carefully studied in the next step.