利用DRG工具开展大型公立医院病组结构调整的实证研究

An Empirical Study on the Use of Diagnosis Related Group Tools for Grouping Adjustments in Large Public Hospitals

目的利用疾病诊断相关分组(diagnosis related group,DRG)数据,分析大型公立医院重点科室病组结构及变化趋势,探究科室病组干预及优化重点,进而推动科室资源合理统筹。方法回顾性收集北京市某大型公立医院2个外科科室2017—2023年的DRG数据。在2个外科科室病例组合指数(case mix index,CMI)出现下降时,均及时采用绩效考核、科室宣教、院内公示等方式进行干预,观察CMI值变化,并分析其病组权重、时间消耗指数、费用消耗指数、低风险组死亡率等变化趋势。结果干预后,外科一权重较低的病组,如甲状腺大手术(KD1)收治比例明显降低,权重较高的病组,如结直肠恶性肿瘤手术(GB2)、胰腺恶性肿瘤手术(HB1)收治比例明显增加;外科二权重较低的病组,如化疗(RE1)收治比例明显降低,权重较高的病组,如肾、输尿管及膀胱恶性肿瘤的大手术(LA1)、肾上腺手术(KC1)、除恶性肿瘤大手术外的肾/输尿管/膀胱手术(LB1)、男性生殖器官恶性肿瘤手术(MA1)收治比例明显增加,2个科室均实现了CMI值上升的目标。从效率、费用、质量指标看,2个科室的时间消耗指数与费用消耗指数均显著低于1,低风险组死亡率均为0。结论大型公立医院立足实际、结合发展目标,通过合理干预,可实现CMI值提升与病组结构优化,提高医疗效率和资源合理利用。

Objective To analyze the disease group structure and its trends in key departments of large public hospitals using diagnosis related group(DRG)data,explore the key points of intervention and optimization of disease groups in departments,and further promote the rational allocation of department resources.Methods We retrospectively collected DRG data from two surgical departments in a large public hospital in Beijing from 2017 to 2023.When the case mix index(CMI)of the two surgical departments declined,interventions such as performance appraisal,department education,and hospital publicity were promptly adopted.The changes in CMI values were observed and the trends in disease group weights,time consumption index,cost consumption index,and mortality rate in low⁃risk groups were analyzed.Results After the interventions,in surgical departmentⅠ,the proportion of patients with lower⁃weight diseases,such as major thyroid surgery(KD1),significantly decreased,while that of patients with higher⁃weight diseases,such as colorectal malignancy surgery(GB2)and pancreatic malignancy surgery(HB1),significantly increased.In surgical departmentⅡ,the proportion of patients with lower⁃weight diseases,such as chemotherapy(RE1),decreased markedly,while that of patients with higher⁃weight diseases,including major surgery for malignancy of kidney,ureter,and bladder(LA1),adrenal gland surgery(KC1),surgery for kidney/ureter/bladder except for major malignancy surgery(LB1),and male genital organ malignancy surgery(MA1),increased significantly.Both surgical departments achieved the goal of increasing their CMI values.In terms of efficiency,cost,and quality indicators,the time consumption index and cost consumption index of the two surgical departments were significantly lower than 1,and the mortality rate in low⁃risk groups was 0.Conclusion Based on actual conditions and development goals,large public hospitals can achieve improvements in CMI values and optimization of disease group structures through reasonable interventions,thereby enhancing medical efficiency and rational utilization of resources.