基于社会网络分析的DRG支付方式改革中医院管理问题的研究

Research on hospital management issues in the DRG payment reform based on social network analysis

目的明确我国医院在实施按疾病诊断相关分组(DRG)支付过程中需优先解决的管理问题,为深化支付方式改革提供参考。方法以DRG、医院和管理等为检索词,系统检索中国知网、万方数据库、PubMed、Embase和Web of Science从建库至2022年4月30日的文献资料,从中提炼出DRG支付方式改革中医院面临的管理问题并构建共词矩阵,运用社会网络分析测算各问题的网络密度和网络中心性,采用熵权-逼近理想解排序(TOPSIS)法对网络中心性指标进行综合评价。结果共纳入32篇文献,提炼出25项DRG支付方式改革中面临的医院管理问题。社会网络分析结果显示,网络密度为0.717,点度中心度、中介中心度和接近中心度排名靠前的问题包括主要诊断选择错误(68,8.842,25),DRG分组器设置不完善(54,8.361,26),其他疾病诊断、手术操作填写问题(60,6.885,26)和病案管理人员专业知识缺乏(54,6.991,25)。熵权-TOPSIS法分析结果显示,相对接近度较高的前4位问题为主要诊断选择错误(1.000),DRG分组器设置不完善(0.871),其他疾病诊断、手术操作填写问题(0.803),以及病案管理人员专业知识缺乏(0.787)。结论病案首页填写错误、DRG分组方案制定欠佳、病案人才专业知识缺乏是医院在DRG支付方式改革中亟待解决的管理问题。建议从加强病案首页质量管理、科学制定DRG分组方案、强化病案人才队伍建设等方面入手,进一步平稳、有序推进改革。

Objective To clarify the immediate administration issues faced by hospitals in China in their implementing the diagnosis-related groups(DRG)payment as a reference for the reform.Methods By using"DRG","hospital",and"administration"as search terms,the authors systematically retrieved literature data from CNKI,Wanfang Data,PubMed,Embase and Web of Science from the establishment of the database to April 30,2022.Based on such data,administration issues pertaining to the reform process were extracted and built into a co-word matrix.The social network analysis was used to measure the network density and network centrality of these administration issues.The entropy weight-technique for order preference by similarity to ideal solution(TOPSIS)method was used to comprehensively evaluate the indicator results of network centrality indicators.Results Of the 32 literatures included,25 issues in hospital administration during the reform of DRG payment method were extracted.As shown in the social network analysis,the network density was 0.717,while the top issues ranking by degree centrality,betweenness centrality and closeness centrality,were inappropriate main diagnosis selection(68,8.842,25),imperfect DRG grouping device setting(54,8.361,26),imprecise recording of other disease diagnosis and surgical operations(60,6.885,26),and poor professional knowledge of medical record managers(54,6.991,25).The top four issues as shown in the entropy weight-TOPSIS analysis were inappropriate main diagnosis selection(1.000),imperfect DRG grouping device setting(0.871),imprecise recording of other disease diagnosis and surgical operations(0.803),and poor professional knowledge of medical record managers(0.787).Conclusions Fill-out errors of medical record homepage,imperfect formulation of DRG grouping plans and poor professional knowledge of medical record manage team,rank the tope administration issues of high priority in implementing the reform of DRG payment methods.It is imperative to strengthen quality control of the medical record homepages,to scientifically formulate the DRG grouping plans,and to improve the construction of medical records professional team,in an effort to the further smooth and orderly implementation of the reform.