基于DRG付费方式改革的精益化管理对手术病种临床路径效益指标的影响

Effect of lean management based on the reform of DRG payment method on clinical pathway benefit indexes of surgical diseases

目的探讨基于疾病诊断相关分组(DRG)付费方式改革的精益化管理对手术病种临床路径效益指标的影响。方法选取实施临床路径管理的13个手术病种,以2021年1~6月(应用基于DRG付费方式改革的精益化管理前)的病例作为对照组,以2021年7~12月(应用基于DRG付费方式改革的精益化管理后)的病例为观察组。比较实施精益化管理前后13个手术病种的效益指标(次均住院费用、次均药品费用、次均耗材费用)的改善程度。结果两组剖宫产行子宫下段剖宫产术的次均药品费用、次均耗材费用,以及混合痔行痔疮切除术的次均药品费用比较,差异均无统计学意义(均P>0.05)。观察组剖宫产行子宫下段剖宫产术的次均费用较对照组升高(P<0.05)。除上述指标外,观察组其余手术病种的次均住院费用、次均药品费用、次均耗材费用较对照组均有不同程度的降低(均P<0.05)。结论基于DRG付费方式的精益化管理有助于提高手术病种的临床路径管理效果,能有效改善手术病种效益指标。

Objective To explore the effect of lean management based on the reform of diagnosis-related groups(DRG)payment method on clinical pathway benefit indexes of surgical diseases.Methods A total of 13 surgical diseases managed by clinical pathway were selected,and the cases from January to June of 2021(before the application of lean management based on DRG payment method reform)were taken as the control group,and the cases from July to December of 2021(after the application of lean management based on DRG payment method reform)as the observation group.The improvement degrees of benefit indexes(average hospitalization expenses per time,average drug expenses per time,and average consumable expenses per time)of 13 surgical diseases were compared between before and after the implementation of lean management.Results There was no statistically significant difference in average drug expenses per time,and average consumable expenses per time of the cases receiving Cesarean section undergoing lower uterine Cesarean section,as well as average drug expenses per time of the cases with mixed hemorrhoid undergoing hemorrhoidectomy between the two groups(all P>0.05).The cases receiving Cesarean section undergoing lower uterine Cesarean section exhibited an elevation of average expenses per time in the observation group as compared with the control group(P<0.05).Except for the aforesaid indices,the average hospitalization expenses per time,average drug expenses per time,and average consumable expenses per time of the remaining surgical diseases in the observation group were decreased to different degrees as compared with the control group(all P<0.05).Conclusion The lean management based on DRG payment method reform is beneficial to improving the clinical pathway management effect of surgical diseases,and to ameliorate benefit indexes of surgical diseases effectively.