DRG付费改革对佛山市某区公立医院肺炎住院患者医疗质量的影响

Study on the Impact of DRG Payment Reform on the Quality of Care for Pneumonia Inpatients in Public Hospitals in a District of Foshan City

目的:分析按疾病诊断相关分组(diagnosis related groups,DRG)付费改革对佛山市某区公立医院肺炎住院患者医疗质量的影响,为我国医保支付方式改革以及医疗质量提升提供参考。方法:收集佛山市某区15家试点公立医院2017-2019年肺炎住院患者病案首页数据,将患者分为医保患者和自费患者两组,采用双组间断时间序列回归模型分析肺炎住院患者在DRG付费改革前后各类医疗质量评价指标的变化。结果:DRG政策实施后,医保患者相比于自费患者30天再入院率没有显著变化(β=0.485,P=0.387),院内死亡率没有明显的变化(β=-0.004,P=0.850),两组患者术后并发症发生率均呈上升趋势,但差异并不显著(β=-0.018,P=0.446)。结论:研究期内,佛山市DRG政策的实施并未对样本医院肺炎住院患者医疗质量产生显著影响。可以推测DRG政策的实施与医院病案首页数据质量监管之间可以起到相互促进的作用,但关于DRG政策对医疗质量的影响还需要更长时间的研究。

Objective:This study aims to analyze the impact of the diagnosis-related groups(DRG)payment reform on the quality of care for pneumonia inpatients in public hospitals in a District of Foshan City,China,and provide insights for healthcare payment reform and improvement of medical quality in the country.Methods:Inpatients data from the first page of medical records from 2017 to 2019 were collected from 15 pilot public hospitals in a District of Foshan City.Inpatients were categorized into two groups:those with medical insurance and self-paying patients.A two-group interrupted time series regression model was employed to assess changes in various medical quality indicators for pneumonia patients,before and after the implementation of the DRG payment reform.Results:Following the DRG policy implementation,there was no significant change in the 30-day readmission rate for insured patients compared to self-paying patients(β=0.485,P=0.387).In-hospital mortality rates also did not show a significant change(β=-0.004,P=0.850),and the rates of postoperative complications increased in both groups,although not significantly(β=-0.018,P=0.446).Conclusion:During the study period,the implementation of the DRG policy in Foshan City did not significantly impact the quality of care for pneumonia patients in the sampled hospitals.It is hypothesized that the implementation of the DRG policy might mutually reinforce the regulation of the quality of data on the first page of hospital medical records.However,further research over a longer period is required to fully understand the impact of the DRG policy on healthcare quality.