DIP实施效果评价指标体系的构建研究

DIP evaluation index system

目的构建一套科学、规范的能适用于综合评价医疗机构按病种分值付费(DIP)实施效果的指标体系,并确定各级指标权重,为开展DIP实践效果评价提供依据,为按病种分值付费政策的完善提供参考。方法通过文献分析初步拟定指标池,运用德尔菲法(Delphi)对22名相关领域的专家进行问卷调查确立指标体系,并利用层次分析法(AHP)确定各指标权重。结果本研究共进行两轮专家咨询,专家积极系数分别为91.00%、100.00%,权威系数均为0.91,两轮专家咨询协调系数均符合标准,专家意见趋于一致。最终构建了3个一级指标(医保基金使用效率、医疗服务管理、患者受益和满意度),9个二级指标,38个三级指标。采用层次分析法确定各级指标权重,其中一级指标中患者受益和满意度(0.4469)权重最高;二级指标中患者医疗费用负担(0.2876)权重最高;三级指标中住院患者满意度(0.1592)权重最高。两轮克隆巴赫α系数均大于0.7。结论本研究应用德尔菲法和层次分析法构建了按病种分值付费实施效果评价体系,具有较高科学性和权威性,可以用于DIP实施效果评价,为各级医保部门和医院管理者进行DIP付费政策评价提供参考。

Objective This paper aims to construct a scientific and standardized index system for evaluating the application effect of Diagnosis-Intervention Packet(DIP)in medical institutions.It seeks to determine the weights of indicators at all levels to provide a basis for evaluating the effectiveness of DIP used in various regions as well as a reference for improving DIP policy.Methods This paper used literature analysis to develop an indicator pool preliminarily.The Delphi method was used to conduct a questionnaire survey with 22 experts to establish the index system.It also used the Analytic Hierarchy Process(AHP)to determine the weight of each index.Results A total of two rounds of expert consultation questionnaires were conducted.The questionnaire exhibited high expert positive coefficients by 91.00%and 100.00%and higher authority coefficients of both 0.91 for two rounds.The coordination coefficients of the two rounds of expert consultation met the standard,and the expert opinions reached a consistence.Additionally,the questionnaire established comprised three primary indicators(efficiency of medical insurance fund,medical service management,patient benefit,and satisfaction),9 secondary indicators,and 38 tertiary indicators.The AHP was used to determine the weight of indicators at all levels.Among the primary indicators,patient benefit and satisfaction had the highest weight(0.4469).Among the secondary indicators,patients’medical cost burden had the highest weight(0.2876).Among the tertiary indicators,the inpatient satisfaction had the highest weight(0.1592).The Cronbach’sαcoefficients of the two rounds were>0.7.Conclusion This paper utilized Delphi method and AHP to establish the evaluation system for assessing the implementation effectiveness of DIP.The approach is highly scientific and authoritative.It can be used to evaluate the application effect of DIP and provide an effective tool for medical insurance and hospital managers at all levels to assess DIP payment policies.