我国DRG支付方式改革对医疗服务绩效影响的系统评价

Systematic evaluation of the impact of DRG payment reform on the performance of medical services in China

[目的]系统评价我国DRG支付方式改革对医疗服务绩效的影响,为我国医保支付方式改革提供参考。[方法]检索Web of Science、PubMed、Embase、CNKI、WanFang Data、VIP和CBM数据库,搜集DRG支付方式改革对医疗服务绩效影响的实证研究文献,根据纳入排除标准筛选并提取数据,采用主题综合法对纳入文献进行综合分析,形成3个核心主题和6项评价指标。[结果]共纳入13篇文献,其中7篇ITS研究,5篇BA研究,1篇RCT研究。结果显示,DRG实施后,医疗服务能力、效率、质量和安全水平均有所提高。医院的CMI指数、DRG组数和DRG总权重数均呈增加趋势,医疗服务能力增加;时间消耗指数和费用消耗指数均呈下降趋势,医疗服务效率提高;低风险组死亡率降低,医疗服务质量和安全水平提高。[结论]DRG有利于提高医疗服务绩效,进而提高医院的精细化管理水平。但存在与国考绩效评价体系之间衔接不足的问题。

Objective To systematically evaluate the impact of the DRG payment reform on the performance of medical services in China,and to provide the reference for the reform of medical insurance payment method in China.Methods Empirical research literatures on the impact of DRG payment reform on the performance of medical services was collected by searching Web of Science,PubMed,Embase,CNKI,WanFang Data,VIP and CBM databases.Data were screened and extracted based on the inclusion and exclusion criteria,and thematic synthesis method was used to conduct a comprehensive analysis of the included literatures,forming three core themes and six evaluation indicators.Results A total of 13 literatures were included,including seven ITS studies,five BA studies,and one RCT study.The statistical results showed that after the implementation of DRG,the capacity,efficiency,quality and safety of medical services have been improved.The hospital's CMI index,the number of DRG groups,and the total weight of DRG showed an increasing trend,indicating an increase in the capacity of medical services.The time consumption index and cost consumption index showed a decreasing trend,indicating improved efficiency of medical services.The mortality rate in the low-risk group decreased,indicating improved quality and safety of medical services.Conclusions DRG is beneficial to improve the performance of medical services,thereby enhancing the fine management level of hospitals.However,there is a problem of insufficient connection with the national monitoring analysis of the performance appraisal.