DIP视角下病种的运营管理精细化

Refined Operation and Management of Disease Types from the Perspective of DIP

目的分析淮安市某三甲医院临床科室优势病种的分布状况和特点,为按病种分值付费(DIP)试点工作提供数据支撑。方法提取淮安市某医院2019—2021年2月35个临床科室所有病种共239595份和国家要求单病种19051份病案作为研究对象,分析不同科室中优势病种在疾病系统、各诊疗组间分布情况;建立病种管理指标体系,描述不同优势病种平均住院天数、费用、结余率及DRG系统的CMI指标等,同时建立病种管理效果评价体系。结果同一病种在同一科室的不同诊疗组间费用、住院天数、结余率、CMI不尽相同、差异较大。结论各科室应明确定位各诊疗组的优势病种,强化各科室病种优势,规范同一病种的费用结构、效率及效益,将低CMI病种适当转入门诊收治,提高门诊收入占比。

Objective:In order to analyze the distribution and characteristics of the dominant diseases in the clinical departments of a 3A hospital in Huai’an City,and to provide data support for the DIP pilot work.Method:A total of 239,595 medical records of all diseases in 35 clinical departments and 19,051 medical records of single disease required by the state were collected from a hospital in Huai’an City from 2019 to February 2021 as research objects to analyze the distribution of dominant diseases in different departments in the disease system and among diagnosis and treatment groups.The index system of disease management was established to describe the average hospitalization days,cost,balance rate and CMI index of the DRG system of different advantageous diseases,and the evaluation system of the effect of disease management was also established.Result:The cost,hospitalization days,balance rate and CMI of the same disease in the same department were different among different diagnosis and treatment groups.Conclusion:Each department should clearly identify the advantageous disease types of each diagnosis and treatment group,strengthen the advantages of each department’s disease types,standardize the cost structure,efficiency,and benefits of the same disease type,appropriately transfer low CMI disease types to outpatient treatment,and increase the proportion of outpatient income.