基于DRG与绩效导向的病床分配模型研究

Study of bed resource allocation model based on DRG and performance orientation

目的通过构建病床资源分配模型,为优化公立医院病床资源配置提供参考。方法本研究基于ReLU激活函数,结合DRG和公立医院绩效考核要求,纳入出院人次、平均住院日、病床使用率、手术占比、四级手术占比、病例组合指数和平均床日收入等指标,构建病床资源分配模型,当医院现有开放病床数大于首次分配的病床数时,可采取二次分配。以某三级甲等综合医院为例,进行模型实例分析。结果经模型分析,某医院2729张开放病床首次分配后结余110张,可进行二次分配。医院40个住院科室的病床分配结果为15个科室加床,3个科室加床并缩短住院日,2个科室不变,1个科室缩短住院日,4个科室减床以及15个科室减床并缩短住院日。结论该病床资源分配模型丰富了指标内涵,体现了专科特性,能够结合医院发展规划和预算管理灵活调整指标,有利于公立医院病床资源的精细化管理。

Objective To build a hospital bed resource allocation model,for the reference of public hospitals in optimizing their bed resource allocation.Methods Based on ReLU activation function,a hospital bed resource allocation model was constructed by combining DRG and public hospital performance appraisal requirements,including discharge person times,average length of stay,hospital bed utilization rate,proportion of surgery,proportion of fourth level surgery,case mix index,average bed day income and other indicators.When the existing number of hospital beds available was greater than the number of hospital beds allocated for the first time,a secondary allocation should be made.A tertiary general hospital was taken as an example for a model analysis.Results As found in the model analysis,among the 2729 beds of the hospital in the first allocation,110 beds were left available for secondary allocation.The results of bed allocation of 40 inpatient departments in the hospital were as follows:15 departments need more beds,3 departments need more beds and shorter length of stay,2 departments need no change,1 department needs shorter length of stay,4 departments need less beds,and 15 departments need less beds and shorter length of stay.Conclusions The bed resource allocation model enriches the connotation of indicators,reflects the specialty characteristics.These indicators can be flexibly adjusted in combination with hospital development planning and budget management,hence conducive to refined management of hospital bed resources in public hospitals.