甘肃省某三甲医院医疗服务能力评价及改进措施探析

Evaluation and Improvement Measures of Medical Service Capacity of A Grade A Tertiary Hospital in Gansu Province

目的基于疾病诊断相关分组(diagnosis-related groups,DRGs)应用过程的研究,评价甘肃省某三级甲等综合医院的医疗服务能力。方法收集作者医院2019-01-01/2021-12-31日住院病案首页数据,对DRGs指标数据进行对比分析,依据“二八原则”以相对权重(relativeweight,RW)和出院人次将全院734个DRGs组划分成优势病种区、核心病种区、重点病种区、普通病种区、提升病种区和下沉病种区,分析各科室病种分区情况。结果该医院总体病例组合指数(case-mixindex,CMI)呈略微下降趋势,出院人数增幅较大,2021年较2019年上升了10.73%,总手术占比、四级手术占比及微创手术占比分别上升了6.56%、3.62%、0.71%;时间消耗指数均<1且持续降低,药耗费用有所增加;有68.31%的出院患者均集中在RW<1的DRGs组;优势病种区和核心病种区各包括30和148个DRGs组,总体CMI分别为2.288和2.539,均处于较高水平;重点病种区和普通病种区各包括90和261个DRGs组,总体CMI相对较低,分别为0.837和0.800;提升病种区和下沉病种区各包括13和63个DRGs组,总体CMI分别为0.303和0.317,均处于较低水平。结论该院的医疗服务能力有所提升,但医疗服务效率有待改善。根据病种分区结果,进一步优化全院病种结构,增加优势病种、核心病种等高权重病种的患者收治比例。以目标值为导向,按月度开展DRGs病种分析和对比,逐步提升全院整体医疗服务能力,为患者提供更加优质的医疗服务。

Objective To evaluate the medical service capacity of a grade A tertiary hospital in Gansu Province based on the research on the application process of diagnosis-related groups(DRGs).Methods Data of the home page of medical records of patients admitted to author's hospital from January 1,2019 to December 31,2021 were collected,com-parative analysis was carried out through DRGs index data.the 734 DRGs groups in the hospital were divided into domi-nant disease areas,core disease areas,key disease areas,common disease areas,upgrading disease areas and descending disease areas according to the"80/20 principle"on the relative weight(RW)and number of discharged,and the disease zoning of each department was analyzed.Results The overall case-mix index(CMI)of the hospital showed a slight downward trend,discharge number was bigger,the number of discharged patients increased by 10.73%in 2021 compared to 2019,and the proportion of total surgeries,fourth-level surgeries and minimally invasive surgeries increased by 6.56%,3.62%and 0.71%respectively;the time consumption index was less than 1 and continued to decrease,and the drug consumption increased;the DRGs group with RW<1 accounted for 68.31%of the discharged patients;the domi-nant disease areas and core disease areas included 30 and 148 DRGs groups respectively,the overall CMI were 2.288 and 2.539 respectively,which were at relatively high level;the key disease areas and common disease areas included 90 and 261 DRGs groups respectively,and the overall CMI was relatively low,which was 0.837 and 0.800 respectively;there were 13 DRGs groups in the upgrading disease areas and 63 DRGs groups in the descending disease areas,and the overall CMI were 0.303 and 0.317 respectively,which were both at relatively low level.Conclusion The medical service capaci-ty of the hospital has been improved,but the efficiency of medical service needs to be improved.According to the results of disease division,the disease structure of the hospital should be further optimized,and the proportion of patients admit-ted to high-weight diseases such as dominant diseases and core diseases should be increased.Guided by the target value,DRGs disease analysis and comparison are carried out on a monthly basis to gradually improve the overall medical service capacity of the hospital and provide better medical services to patients.