初级保健质量 开放获取

抽象的

A Study on Implementation of Inpatient Treatment by DRG-Based Reimbursement Model in China

Huan Han, Maksim Semenov, Ruifang Hao, Dong Liang, Suyun Yong, Xingang Wei, Nan Zhou, Peng Zhang

Purpose: This study aimed to evaluate the influence of DRG-based hospital payment system approach on implementation of inpatient treatment.

Methods: This study was largely based on retrospective analysis of DRG-based hospital payment data from third class hospital for the period of October 2021 to February 2022 including determination of diagnosis groups with most significant balance of payment loss and corresponding departments, development of pathways to DRG-based inpatient treatment, pre-checking of prescriptions, in process education of clinical pharmacists and case follow up, comments and penalty measures. The rational drug use, drug income proportion and DRG-related medical services capability assessment (manageable number of DRGs, CMI, average hospital stay, time consumption index and resource consumption index) of departments with loss were compared before and after intervention.

Results: Data analysis revealed that BR23 (cerebral ischemic stroke with accompanying diseases or complications) balance of payments loss was most significant with higher average drug income proportion than such in groups of balance of payments surplus. The Neurology Department BR23 demonstrated significant balance of payment deficit. Therefore, the ischemic stroke drug clinical treatment pathway was successfully developed and after intervention, prescription errors counted 14.14, therefore demonstrated 6.89% decrease and at the same time medicines consumption rate was 27.17% with 9.43% decrease. The number of manageable number of DRGs increased by 3, CMI increased by 0.14, average length of stay decreased by 0.8 days, time consumption index and resource consumption index decreased by 0.11 and 0.18 respectively.

Conclusion: DRG-based hospital payment management of inpatient treatment provided theoretical support for DRG code-based reimbursement cost control and scientific cost control and has improved quality management of hospital service.