基于间断时间序列分析的DRG-PPS改革效果研究

目的：分析按疾病诊断相关分组预付制（DRG-PPS）改革对浙江金华7家试点医疗机构运行的影响。方法：收集2015年7月-2017年6月期间改革试点医疗机构7类运行指标的月度数据，将数据分为改革前（2015年7月-2016年6月）和改革后（2016年7月-2017年6月）两阶段，采用间断时间序列数据的分段回归模型分析改革前后各类指标趋势的变化。结果：三级医院各类指标时间趋势无显著差异，出院人数保持增长趋势，住院费用药占比和医务性费用占比分别保持下降和上升趋势。二级医院出院人数增速放缓，人均住院费用改革后呈下降趋势，次均门诊费用由降转升。乡镇卫生院人均住院费用和次均门诊费用持续下降，但改革后降幅趋缓。结论：DRG-PPS改革前后试点医疗机构平均住院日变化趋势无显著差异，三级医院运行平稳，二级医院存在住院费用向门诊费用转移的可能，乡镇卫生院患者费用负担有回升趋势。

The impact of a pilot reform on the diagnosis-related-groups based prospective paymentsystem: an interrupted time-series analysis

Objective: To analyze the impacts of the diagnosis-related groups based prospective payment system (DRG-PPS) reforms on the performance of seven pilot hospitals in Jinhua of Zhejiang province. Methods: Monthly data on seven performance indicators of the pilot hospitals were collected between July 2015 and June 2017 and divided into two sub-periods:(1) Before the reforms (July, 2015, to June, 2016); and (2) after the onset of the reforms (July, 2016, to June, 2017). The changes in the trend of indicators were tested by doing interrupted time-series analysis using segmented regression models. Results: For the tertiary hospitals, there was no significant change in the trend of various indicators, the number of discharged kept increasing and the proportion of drugs and hospitalization expenses experienced a decreasing and a rising trend, respectively. As for tertiary hospitals, the number of outpatients continued to increase, but at a slower pace than before the reforms in the secondary hospitals, and the per capita hospitalization expense began to decline after the reform due to a considerable decrease in slope. However, the outpatient expense per visit turned to rise due to a substantial slope increase. For the township hospital, both the per capita hospitalization and outpatient expenses per visit underwent a relatively slow declining trend after the reform. Conclusions: The average length of stay in the pilot hospitals did not change significantly before and after the DRG-PPS reforms. There was a smooth operation in the tertiary hospitals after the reforms. In the secondary hospitals, there was the possibility of transferring hospitalization expenses to outpatient fees; and the cost kept an increasing trend in the township hospitals.