DRG付费对医生行为和医疗质量的影响研究:以踝关节和脊柱融合术为例

目的探究DRG付费对医生诊疗行为和医疗质量的影响。方法从11家实施DRG付费或模拟测算的三级综合医院中选取12名骨科医生进行半结构化访谈，采用Colaizzi 7步法分析。结果共识别重要陈述308条，形成治疗决策、环节把控、患者管理、医疗质量4项基本结构。DRG付费后，医生更关注住院费用，以检查和手术为代表的诊疗行为发生了变化；医生诊疗行为的改变可能引起医疗质量的变化。结论医生应主动控制成本，制定合理的诊疗方案；医院需强化临床指南的使用，加强对医疗质量的考核，以防范医生不规范诊疗行为的发生。

Impact of DRG Reform on Doctors' Behaviors and Medical Quality: Taking Ankle and Spinal Arthrodesis as Examples

Objective To explore the influence of Diagnosis-Related Groups (DRG) payment on doctors' diagnosis and treatment behavior and medical quality.Methods12 orthopedic surgeons were selected for semi-structured interviews from 11 tertiary general hospitals which implemented DRG payment or simulated calculation, and the data were analyzed by Colaizzi seven-step method.ResultsA total of 308 important statements were identified, from which 4 basic structures were extracted including treatment decision-making, link control, patient management and medical quality. After the implementation of DRG, doctors became more cost-sensitive, and changed treatment behavior represented by examination and operation. Changes in the behavior of doctors can lead to changes in the quality of care.Conclusion Doctors should take the initiative to control costs and make reasonable diagnosis and treatment plans. Furthermore, hospitals should strengthen the use of clinical guidelines, strengthen the assessment of medical quality, in order to prevent the occurrence of doctors treatment non-standard behavior.