以价值为导向的住院康复服务价值调节因子构建研究

目的: 本研究旨在建立实现康复治疗效果可比的价值调节因子,为将康复服务价值作为医保支付依据、基于现行医保制度建立按价值付费机制提供可行思路。方法: 课题组于2022年1月1日-2023年3月31日收集样本医院脑损伤住院患者功能相关信息,并与样本地区医保结算清单数据库关联。采用神经网络模型拟合康复结果与康复效果影响因素之间的函数关系,根据康复结果实际值与预测值差值的分布区间判断康复服务价值。结果: 共计878例脑损伤患者的住院康复病案与医保结算清单资料纳入分析;根据预测精度评价指标及其标准,选取了最优模型,并根据其预测结果对康复治疗效果进行了评价,确定了包含四个档次的价值调节因子。结论: 本研究构建的价值调节因子,不仅为评价住院康复服务治疗效果、实现康复效果可比提供了重要工具,也为进一步推动医保对住院康复服务实施按价值付费提供了可行方向。

Research on the construction of a value adjustor for the inpatient rehabilitation services based on the principle of value-based health care

Objectives: This study aims to establish the value adjustor that can achieve comparable rehabilitation treatment effects, and provide feasible ideas for using the rehabilitation service value as the basis for medical insurance payment and establishing a value-based payment mechanism based on the current medical insurance system. Methods: The research group collected functional information related to brain injury inpatients in sample hospitals from January 1, 2022 to March 31, 2023, and linked it with the medical insurance settlement list database in the sample area. Using a neural network model to fit the relationship between rehabilitation outcomes and factors influencing rehabilitation effects, the value of rehabilitation services was determined based on the distribution of the difference between the actual and predicted values of rehabilitation outcomes. Results: A total of 878 inpatient rehabilitation medical records and medical insurance settlement list data of patients with brain injury were included in the analysis. Based on the prediction accuracy indicators and standards, the optimal model was selected, whose prediction results were used to evaluate rehabilitation treatment effects, and the value adjustor that included four levels were determined. Conclusions: The value adjustor constructed in this study not only provides an important tool for evaluating the treatment effects of inpatient rehabilitation services and achieving comparable rehabilitation effects, but also provides a feasible direction for further promoting the value-based payment for inpatient rehabilitation services.