基于DRG的专科标准化平均住院日目标设定研究

Research of Setting the Standardized Average Length of Stay Objectives for Specialties Based on DRG

目的 探索DRG下专科标准化平均住院日目标设定方法,研究其科学性和合理性。方法 以某省同级医院大数据计算出的每个疾病诊断相关组的平均住院日为依据,计算医院各专科当前病组结构下“标准化平均住院日”,结合医院总体控制目标和专科发展水平,设定专科平均住院日控制目标。结果 专科“标准化平均住院日”以大数据为基础,按照病种结构进行标准化,各专科实际平均住院日与标准化平均住院日一致性检验(ICC)=0.54,差异有统计学意义(P<0.01);标准化平均住院日更加符合医院管理的特点和实际,可以根据科室病种结构的变化及时调整,灵活机动,更易于被临床科室接受(χ^(2)=4.57,P<0.05);采取综合措施后,平均住院日逐年下降,从2018年的8.19天降至2021年的6.33天(F=913.9,P<0.001),取得明显成效。结论 基于DRG的专科标准化平均住院日目标设定研究,方法科学,目标合理,实施有效。

Objective It explored the method of setting the standardized average length of stay(ALOS) object for specialties based on DRG,and investigated its scientificity and rationality. Methods Taking the ALOS of each disease diagnosis-related group according to the big data of hospitals on the same level in the province as a basis, the“standardized ALOS”of specialties under the structure of disease groups in the previous year are calculated for each specialty of hospitals. In conjunction with the general control objectives of hospitals and the development level of specialties, the ALOS control objectives of specialties are determined scientifically and rationally. Results The“standardized ALOS”of specialties are standardized with big data and according to the structure of diseases. The actual ALOS for each specialty and the standardized ALOS consistency test(ICC) =0.54, showing a statistically significant difference(P<0.01);The ALOS is more in line with the characteristics and practicality of hospital management. It can be timely and flexibly adjusted in accordance with changes disease structure of specialties.There is a significant reduction in the number of people who raise doubts, suggesting that it is easily accepted by clinical departments(χ^(2)=4.57,P<0.05);following the adoption of comprehensive measures,the ALOS for the year2021 has been shortened to 6.31 days from 8.19 days in 2018(F=913.9, P<0.001), yielding significant results.Conclusion The standardized ALOS objective setting for specialties based on DRG can be a scientific approach to hospital management with reasonable objectives and effective implementation.