医疗质量管理视角下某精神专科医院DRGs评价的实践与思考

Practice and Thinking of DRGs Evaluation in a Psychiatric Hospital From the Perspective of Medical Quality Management

目的:通过对某精神专科医院DRGs运行结果的分析,探讨DRGs评价对医疗质量管理的影响。方法:利用2022年某精神专科医院市医保DRGs结算数据,分析该院医疗服务水平、科室医疗质量、精神科DRGs入组情况。结果:2022年该院CMI值、时间消耗指数、费用消耗指数均高于全市平均水平;各科室DRGs指标结果差异较大;精神科收治疾病诊断DRGs入组情况具有特异性。结论:应提高医院运营效率,降低时间、费用消耗指数;结合指标考核,调整医疗资源,实现精细化管理;根据精神专科医院特色,细化医保DRGs结算方案。

Objectives:Through the analysis of the operation results of DRGs in a psychiatric hospital,the enlightenment of DRGs evaluation to medical quality management was discussed.Methods:Based on the settlement data of municipal medical insurance DRGs of a psychiatric hospital from January 1,2022 to December 31,2022,the medical service level,medical department quality and psychiatric DRGs enrollment of the hospital were analyzed.Results:In 2022,the CMI value,time consumption index and expense con-sumption index of the hospital are all higher than the city average;The results of DRGs index vary greatly among departments.The in-clusion of DRGs in psychiatric diagnosis was specific.Conclusion:Improve hospital operation efficiency and reduce time and cost con-sumption index;Combined with the index assessment,adjust the medical resources to achieve fine management;According to the char-acteristics of psychiatric hospitals,the DRGs settlement scheme of medical insurance was refined.