基于DRGs绩效体系的重庆市三级医院住院医疗服务能力分析

目的基于DRGs绩效体系对重庆市24家三级医院2018年1月1日-12月31日住院医疗服务能力进行评价,为下一步地区卫生健康事业发展提供参考。方法以国家版诊断相关分组器(CN-DRGs)为基础标准,参照北京版诊断相关组分组器(BJ-DRGs),结合重庆本地病例特征及专家论证,构建本地化分组标准(CQ-DRGs)。利用国家卫生统计网络直报信息采集的住院病案首页数据,通过重庆市住院医疗服务绩效系统,从服务能力、服务效率、医疗安全3个维度共计5个指标进行分析。结果2018年度前五的主要诊断大类(Major Diagnostic Category,MDC)依次为MDCE(呼吸系统疾病)、MDCG(消化系统疾病)、MDCB(神经系统疾病)、MDCF(循环系统疾病)、MDCI(肌肉、骨骼系统疾病);DRGs组数超过600组的共有19家,病例组合指数(CMI)超过1的共有7家,费用消耗指数和时间消耗指数在四个象限分布较为平均,低风险组死亡率平均为0.37%,仅有两家医院高于平均水平,共有14家医院综合评分得分为正值。结论2018年度重庆市三级综合医院服务能力总体较强,收治的DRGs组数较多,技术难度较大,不同三级医院时间消耗指数与费用消耗指数差异较大,主城区外医院服务效率较高,低风险组死亡率控制较好。

Analysis on the Ability of Inpatient Medical Service of Chongqing Tertiary Hospital Based on Drgs Performance System

Objective Based on DRGs performance system,to evaluate the inpatient medical service capacity of 24 tertiary hospitals in Chongqing from January 1 to December 31,2018,and to provide reference for the development of regional health services in the next step.Methods Based on the home page data of inpatient medical records collected by health statistics network direct report information,through Chongqing inpatient medical service performance system,five indicators were analyzed from three dimensions of service ability,service efficiency and medical safety.Results In 2018,the main diagnostic categories of the top five(Major Diagnostic Category),MDC were MDCE(respiratory system diseases),MDCG(digestive system diseases),MDCB(nervous system diseases),MDCF(circulatory system diseases)and MDCI(musculoskeletal diseases).There were 19 in DRGs group and 7 in case mix index(CMI)>1.The cost consumption index and time consumption index were evenly distributed in the four quadrants.The average mortality rate in the low-risk group was 0.37%.Only two hospitals were higher than the average,and a total of 14 hospitals were scored as positive.Conclusion In 2018,the service capacity of Chongqing tertiary general hospitals is generally strong,the number of DRGs groups admitted is more,and the technical difficulty is greater.There are great differences in time consumption index and cost consumption index among different tertiary hospitals.The service efficiency of hospitals outside the main urban area is higher,and the mortality rate of low-risk group is better controlled.