目的:探讨医保专员干预管理在疾病诊断相关分组(diagnosis-related groups,DRGs)支付模式下医保的盈亏情况,为优化诊疗过程及控制不合理的医疗收费提供管理依据和决策参考。方法:收集南京市某三甲医院2022年1月-7月胃肠外科胃癌住院病...目的:探讨医保专员干预管理在疾病诊断相关分组(diagnosis-related groups,DRGs)支付模式下医保的盈亏情况,为优化诊疗过程及控制不合理的医疗收费提供管理依据和决策参考。方法:收集南京市某三甲医院2022年1月-7月胃肠外科胃癌住院病例医保DRGs系统数据,根据有无医保专员干预管理分为干预组和对照组,统计分析医保专员干预管理对该病种在DRGs中盈亏情况的影响,评估管理效果。结果:本研究共收集206例患者信息,其中干预组127例,对照组79例。干预组盈余多于对照组(P=0.025),DRGs分组中干预组严重并发症或合并症(Major Complication or Comorbidity,MCC)组和并发症或合并症(Complication or Comorbidity,CC)组的入组人数显著多于对照组(P=0.007)。随着干预的进行,胃癌手术患者贡献的病例组合指数(case mix index,CMI)值呈上升趋势,医保结余呈现正增长趋势。结论:通过医保专员的干预可明显增加DRGs中胃癌组医保节余费用,指导胃癌病种合理化分配费用,优化资源配置,进一步管控医疗成本,降低患者住院费用。展开更多
Background Despite the increasing focus on strengthening One Health capacity building on global level,challenges remain in devising and implementing real-world interventions particularly in the Asia-Pacific region.Rec...Background Despite the increasing focus on strengthening One Health capacity building on global level,challenges remain in devising and implementing real-world interventions particularly in the Asia-Pacific region.Recognizing these gaps,the One Health Action Commission(OHAC)was established as an academic community for One Health action with an emphasis on research agenda setting to identify actions for highest impact.Main text This viewpoint describes the agenda of,and motivation for,the recently formed OHAC.Recognizing the urgent need for evidence to support the formulation of necessary action plans,OHAC advocates the adoption of both bottom-up and top-down approaches to identify the current gaps in combating zoonoses,antimicrobial resistance,addressing food safety,and to enhance capacity building for context-sensitive One Health implementation.Conclusions By promoting broader engagement and connection of multidisciplinary stakeholders,OHAC envisions a collaborative global platform for the generation of innovative One Health knowledge,distilled practical experience and actionable policy advice,guided by strong ethical principles of One Health.展开更多
文摘目的:探讨医保专员干预管理在疾病诊断相关分组(diagnosis-related groups,DRGs)支付模式下医保的盈亏情况,为优化诊疗过程及控制不合理的医疗收费提供管理依据和决策参考。方法:收集南京市某三甲医院2022年1月-7月胃肠外科胃癌住院病例医保DRGs系统数据,根据有无医保专员干预管理分为干预组和对照组,统计分析医保专员干预管理对该病种在DRGs中盈亏情况的影响,评估管理效果。结果:本研究共收集206例患者信息,其中干预组127例,对照组79例。干预组盈余多于对照组(P=0.025),DRGs分组中干预组严重并发症或合并症(Major Complication or Comorbidity,MCC)组和并发症或合并症(Complication or Comorbidity,CC)组的入组人数显著多于对照组(P=0.007)。随着干预的进行,胃癌手术患者贡献的病例组合指数(case mix index,CMI)值呈上升趋势,医保结余呈现正增长趋势。结论:通过医保专员的干预可明显增加DRGs中胃癌组医保节余费用,指导胃癌病种合理化分配费用,优化资源配置,进一步管控医疗成本,降低患者住院费用。
基金supported in whole by the Bill&Melinda Gates Foundation(No.INV-046218)
文摘Background Despite the increasing focus on strengthening One Health capacity building on global level,challenges remain in devising and implementing real-world interventions particularly in the Asia-Pacific region.Recognizing these gaps,the One Health Action Commission(OHAC)was established as an academic community for One Health action with an emphasis on research agenda setting to identify actions for highest impact.Main text This viewpoint describes the agenda of,and motivation for,the recently formed OHAC.Recognizing the urgent need for evidence to support the formulation of necessary action plans,OHAC advocates the adoption of both bottom-up and top-down approaches to identify the current gaps in combating zoonoses,antimicrobial resistance,addressing food safety,and to enhance capacity building for context-sensitive One Health implementation.Conclusions By promoting broader engagement and connection of multidisciplinary stakeholders,OHAC envisions a collaborative global platform for the generation of innovative One Health knowledge,distilled practical experience and actionable policy advice,guided by strong ethical principles of One Health.
