基于DRG的医保服务质量评价体系构建及应用研究

Research on the Construction and Application of DRG-based Medical Insurance Service Quality Evaluation System

江苏省人民医院以疾病诊断相关分组(DRG)支付方式改革为契机,基于激励行为理论,采用文献研究、专家咨询、关键绩效指标法拟定评价指标,应用PDCA管理工具构建持续改进的医保服务质量评价体系。介绍了医保服务质量评价体系构建过程及其在医保绩效管理中的应用,实施效果分析结果显示:DRG运营向好,病种组结构优化,医疗质量和效率持续提升,医疗服务评价得分趋好。

Jiangsu Provincial People’s Hospital takes the reform of DRG payment method as an opportunity,based on the theory of incentive behavior,uses literature research,expert consultation,and key performance indicator methods to develop evaluation indicators,and applies PDCA management tools to establish a continuously improving medical insurance service quality evaluation system.It introduces the process of medical insurance service quality evaluation system construction and its application in medical insurance performance management,and analyzes the implementation effect:DRG operation is improving,disease group structure is optimized,medical quality and efficiency continue to improve,and medical service evaluation scores are improving.