以患者获益为核心,促进医联体可持续发展

Focusing on the Benefits of Patient,Promoting the Sustainable Development of Medical Consortium

医联体作为推进分级诊疗制度的实践载体,对于平衡医疗资源、提升医疗服务效率具有重大意义。本文基于以北京协和医院为核心的“1+5+1”医联体合作模式,借助疾病诊断相关分组(diagnosis related group,DRG)指标,分析了医联体建设历程中患者、成员医院、牵头医院的获益情况,以期为构建医联体评价体系提供参考。医联体建设不仅提高了患者对优质医疗资源的可及性,同时提升了成员医院的诊疗水平,并为牵头医院调整病种结构、提升学科建设水平提供了空间。DRG作为医保支付方式改革的核心,通过病例组合指数和DRG组数等指标,为病例管理和病种结构优化提供了客观、可量化的数据支撑,有效引导医疗资源合理分配和医联体内病种/术种调整。综合利用DRG评价指标,可构建一套多维度的医联体建设评价体系,为医联体深度合作提供明确的指导方向,从而整体推动医联体良性可持续发展,实现多方共赢。

As a practical carrier for promoting the tiered diagnosis and treatment model,the medical consor⁃tium is of great significance for balancing medical resources and boosting medical service efficiency.The construction of medical consortiums not only improves the accessibility of high⁃quality medical resources for pa⁃tients,but also enhances the diagnostic and treatment level of member units.Meanwhile,it provides space for the leading hospital to adjust the structure of diseases and improve the level of discipline construction.As the core of medical insurance payment reform,DRG,through indicators such as the case mix index(CMI)and the number of diagnosis related group(DRG),provides objective and quantified data support for case management and disease structure optimization,thus effectively guiding the rational allocation of medical resources and the adjustment of diseases and surgical types within the medical consortium.Comprehensive use of DRG evaluation indicators can construct a multidimensional medical consortium construction evaluation system,provides a clear direction for medical consortium cooperation,thereby promoting the overall healthy and sustainable development of medical consortiums and achieving a win⁃win situation for all parties involved.This paper,based on the“1+5+1”medical consortium cooperation model centered around Peking Union Medical College Hospital,utilizes DRG indicators to analyze the benefits for patients,member hospitals,and the leading hospital during the medical consortium construction process,with the hope of providing reference for the construction of a medical consortium evaluation system.