病例组合指数纳入医院安全绩效考核体系后的探索

Exploration of case-mix index value into hospital safety performance appraisal system

目的探究将疾病诊断相关分组(DRGs)中病例组合指数(CMI)纳入上海某三级甲等公立医院医疗安全绩效考核体系后对医疗质量与安全的推动作用。方法选取上海某试点DRGs支付的三级甲等医院在2019年度(试点前)至2020年度(试点后)的29个临床科室年度CMI平均值、临床医师对医疗安全考核制度的满意度、全院执业医师自费购买执业医师责任保险的比例、医疗纠纷的发生率、医疗纠纷赔款率等观察数据进行分析,比较试点前后全院各临床科室CMI年度平均值、全院执业医师自费购买执业医师责任保险的比例、临床医师对考核制度的满意度、医院医疗纠纷的发生率和赔款率。结果试点后,全院29个临床科室CMI年度平均值、自费购买执业医师责任保险的比例均高于试点前,差异有统计学意义(P<0.05)。试点后,临床医师对考核制度的满意度优于试点前,差异有统计学意义(P<0.05)。试点后,医院医疗纠纷发生率、医疗纠纷赔款率均低于试点前,差异有统计学意义(P<0.05)。结论将CMI纳入医院安全绩效考核体系后,医院整体的收治病种含金量、临床医师对医疗安全的重视程度、风险转移意识、抗风险能力及对考核制度的满意度、医疗安全指标均有明显提升,对医疗质量与安全有正向推动作用。

Objective To explore the promotion effect of case-mix index(CMI)of diagnosis related groups(DRGs)on medical quality and safety after it was incorporated into the medical safety performance appraisal system of a ClassⅢand Class Apublic hospital in Shanghai.Methods The average value of annual CMI of 29 clinical departments,the satisfaction of clinicians with the medical safety assessment system,the proportion of practicing physicians in the whole hospital who purchased practicing physicians'liability insurance at their own expense,the incidence of medical disputes,and the compensation rate of medical disputes were analyzed in a third class A hospital with DRGs payment from 2019(before the pilot)to 2020(after the pilot),the changes in the annual average value of CMI in all clinical departments of the hospital,the proportion of medical practitioners in the hospital who purchased medical practitioners'liability insurance at their own expense,the satisfaction of clinicians with the assessment system,the incidence of medical disputes in the hospital and the compensation rate before and after the pilot were compared.Results After the pilot,the annual average value of CMI and the proportion of self-funded medical practitioners'liability insurance in 29 clinical departments were higher than those before the pilot,the differences were statistically significant(P<0.05).After the pilot,the satisfaction of clinicians to the assessment systemwas better than that before the pilot,and the difference was statistically significant(P<0.05).After the pilot,the incidence of hospital medical disputes and the compensation rate of medical disputes were lower than before the pilot,and the differences were statistically significant(P<0.05).Conclusion After CMI is incorporated into the hospital safety performance appraisal system,the gold content of the hospital as a whole,the degree of clinicians'attention to medical safety,the awareness of risk transfer,the ability to resist risks,the satisfaction with the assessment system,and the medical safety indicators have been significantly improved,which has a positive role in promoting the medical quality and safety.