DRG支付制度对护理行为影响的扎根理论研究

The impact of DRG-based hospital payment system on nursing behavior:a grounded theory study

目的基于扎根理论研究DRG支付制度对护理行为的影响及其作用机制,为护理实践指导提供理论依据。方法对22名DRG付费试点医院护士进行半结构化面对面访谈,采用程序化扎根理论的范式收集和分析资料。结果形成284条初始概念,55个初始范畴,16个副范畴和4个主范畴,建构了DRG支付制度对护理行为的影响机制理论模型,由政策激励、内在驱动、外部调节、护理行为4个维度组成。结论政策激励作用于护士产生内在驱动,并通过外部调节影响护理行为。为引导护理行为产生正向激励,应健全DRG支付制度和监管保障机制,完善护理绩效评价体系,优化DRG相关培训,保证护理质量优先,设立DRG协作管理小组。

Objective To explore the impact of DRG-based hospital payment system on nursing behavior and its mechanism based on the grounded theory,and to provide reference for nursing practice.Methods A semi-structured face-to-face interview was conducted among 22 nurses who work in hospitals piloting DRGs.Data were collected and analyzed using open,axial and selective coding procedures according to the grounded theory principles.Results A total of 284 initial concepts,55 initial categories,16 sub categories and 4 core categories were formed.A theoretical model of the impact of DRG payment system on nursing behavior was developed,including four dimensions of policy incentive,internal motivation,external regulation and nursing behavior.Conclusion Policy incentives have a positive influence on internal motivation of nurses,and affect nursing behavior through external regulation.In order to guide nursing behavior to generate positive outcomes,we should perfect DRG schemes,strengthen monitoring mechanism,optimize nursing performance evaluation system and DRG related training,give priority to nursing quality,and build DRG collaborative management team.