医院绩效评价视角下的北京地区DRG权重算法优化研究

DRG weight algorithm optimization in Beijing from the perspective of hospital performance evaluation

目的基于医院绩效评价视角,结合公立医院高质量发展导向,优化疾病诊断相关分组(DRG)权重计算方法,以期更准确反映临床实际。方法对北京地区二级及以上医院2021年3256701例住院病案首页数据,分别使用支付DRG权重、五分类DRG权重、优化DRG权重3种算法,计算各DRG权重,分析不同算法的差异。使用3种DRG权重算法计算二级、三级医院的全院和重点DRG所属临床专科的CMI,反映不同算法的绩效评价结果。结果单因素方差分析结果显示,3种DRG权重算法差异有统计学意义(P=0.019)。优化DRG权重与支付DRG权重比较,重点DRG中BD29-神经刺激器植入或去除术的权重由7.77降低至4.61,LA19-肾脏肿瘤手术的权重由2.06升高至2.58;与五分类DRG权重比较,平均住院日较长的ES31-呼吸系统感染/炎症,伴严重并发症或合并症的权重由2.36降低至1.72,平均住院日较短的CB39-晶体手术的权重由0.22升高至0.30。使用优化DRG权重与五分类DRG权重计算CMI比较,各类医院与临床专科CMI均有不同程度提升,三级医院CMI由1.02上升至1.20,二级医院CMI由0.88上升至0.95,二级、三级医院CMI的差距更加明显。结论优化DRG权重与支付DRG权重相比,能更好地反映医疗技术价值;与五分类DRG权重相比,能更好地反映不同级别医院CMI的差异。

ObjectiveTo optimize the diagnosis-related groups(DRG)weight calculation method based on the perspective of hospital performance evaluation and the high-quality development orientation of public hospitals.MethodsUsing the first page data of 3256701 inpatient medical records from secondary and tertiary hospitals in Beijing from January to December 2021,three algorithms including payment DRG weight,five-category DRG weight,and optimized DRG weight were used to calculate the weights of each DRG,and the differences between different algorithms were analyzed.The case-mix index(CMI)of the entire hospital and the clinical specialties to which the key DRG belongs in secondary and tertiary hospitals was calculated by using the three DRG weight algorithms,to reflect the performance evaluation results of different algorithms.ResultsThe results of one-way ANOVA showed that there was a significant difference(P=0.019)among the three DRG weight algorithms.Comparing the optimized DRG weight with the payment DRG weight,the weight of BD29(neural stimulator implantation or removal surgery)in the key DRG decreased from 7.77 to 4.61,and the weight of LA19(renal tumor surgery)increased from 2.06 to 2.58;Compared with the five-category DRG weight,the weight of ES31(respiratory infection/inflammation with severe complications or comorbidities)decreased from 2.36 to 1.72,and the weight of CB39(crystalloid surgery)increased from 0.22 to 0.30.Comparing the use of optimized DRG weights and five-category DRG weights to calculate CMI,all types of hospitals and clinical specialties showed varying degrees of improvement in CMI.The CMI of tertiary hospitals increased from 1.02 to 1.20,and the CMI of secondary hospitals increased from 0.88 to 0.95.The difference in CMI between secondary and tertiary hospitals was even more pronounced.ConclusionsOptimized DRG weights could better reflect the value of medical technology compared with the payment DRG weights.Compared to five-category DRG weights,optimized DRG weights could better reflect the differences in CMI of different levels of hospitals.