DRG支付方式对临床医师医疗行为的影响

The Influence of DRG Payment Method on Clinic Physician’s Medical Behavior

目的 研究DRG支付方式对医师医疗行为的影响,为优化诊疗过程及控制不合理医疗收费提供管理依据和决策辅助。方法 某院应用基于DRG指标模块的精益化管理系统前2019年1月1日-2019年12月31日全部住院病案76 382份设为对照组;管理系统应用后2021年1月1日-2021年12月31日全部住院病案61 907份为研究组,统计分析收治相同病种的大型检查服务量和检查预约等待时间等医疗服务效率、药占比、耗材占比、住院费用结构、诊疗收治难度CMI值、7日再入院率和死亡率等医疗质量安全,评估管理效果。结果 研究组大型检查服务量上升13.61%,检查预约平均等待时间降低11.21%,药占比、耗材占比、检查费分别下降13.29%、15.28%和10.44%,手术费和治疗费增长70.13%和28.82%,平均CMI值上升12.85%。7日再入院率、院内感染率和死亡率,2组比较不具有统计学差异(P>0.05)。结论 基于DRG指标的精益化管理系统对医师行为的评价与监管能有效提高医疗服务效率和收治难度、优化住院费用结构,对医疗质量安全无明显影响,可引导医师医疗行为与DRG付费改革相向而行。

Objectives This study aims to investigate the influence of DRG payment method on clinic physician’s medical behavior, in order to provide management bases and decision aids for optimizing the treatment process and controlling unreasonable hospital charges. Methods All 76,832 inpatient medical records from a hospital before the application of lean management system based on DRG from January 1, 2019 to December 31, 2019 were selected into the control group. All 61,907 inpatient medical records after the application of the management system from January 1, 2021 to December 31, 2021 were selected into the investigation group. This study statistically analyzed the medical quality safeties, such as the medical treatment efficiency of large-scale inspection service volume and the waiting time after inspection reservation in the same DRG, proportion of drug cost, proportion of consumable cost, construction of hospitalization expenses, CMI value of the difficulty level in diagnosis and treatment, readmission rate after seven days and death rate. The management effectiveness was evaluated. Results The large-scale inspection service volumein the investigation group increased by 13.61%. The waiting time after inspection reservation decreased by 11.21%. Proportion of drug cost, proportion of consumable cost and inspection expenses decreased by 13.29%, 15.28% and 10.44% respectively. Surgical expenses and treatment expenses increased by 70.13% and 28.82% respectively. The average CMI value increased by 12.85%. Readmission rate after seven days, nosocomial infection rate and death rate did not show any statistically significant differences between the control and investigation groups(P>0.05). Conclusions The lean management system based on DRG index on the evaluation and supervision of physicians’ behavior effectively improves the medical treatment service efficiency and difficulty level of admission and optimizes the construction of hospitalization expenses. This system does not significantly affect medical quality safety, and it is able to lead the physicians’ medical treatment behavior and the reformation of DRG payment into the same developmental direction.