Investigation and analysis of the effect of DRGs on the medical service performance evaluation in public hospitals

doi:10.3877/cma.j.issn.1674-392X.2023.01.027

Abstract

Abstract:

Objective

To study the effect of DRGs on patient service, doctors' diagnosis and treatment behavior, and the utilization of medical resources, and provide reference for promoting the reform of DRGs and improving medical and health service performance evaluation.

Methods

An extensive survey was conducted in public hospitals in Beijing, using questionnaire survey and result analysis. A total of 233 people participated in the survey, including 191 doctors, 20 medical technicians, 9 nurses and other people, and 13 administrative staff. SPSS 26.0 was used for data processing. The sample t-test and one-way ANOVA were used, and corresponding regression equations were established. The effect of DRGs reform on hospitals, doctors and patients under different demographic conditions was analyzed. The total score was considered as the dependent variable, and variables with statistical significance in the univariate analysis were included as independent variables for the generalized linear regression analysis. The influence of different factors on the total score was analyzed, and positive and negative factors were determined.

Results

In terms of the effect on patients' medical services, factors including income, whether DRGs pilot, whether DRG performance rewards and punishment measures are available, marital status, position, duty, satisfaction degree of medical service performance evaluation, education background, age and length of service have significant effect (P<0.05). In terms of the effect on doctors' diagnosis and treatment behavior and medical resources, all the above factors have statistical significance except marriage (P<0.05). The total score is taken as the dependent variable, and variables with statistical significance in the univariate analysis are taken as the independent variables for the generalized linear regression analysis. Results showed that income dissatisfaction, no implementation of DRGs pilot hospitals, and no DRG performance rewards and punishment measures had a negative effect on the total score. Education and age had a positive effect on the total score. The higher the education and the older the age, the higher the total score.

Conclusion

According to the different influence of different demographic characteristics on the cognitive level of DRGs, the targeted multi-channel training should be carried out, to strengthen the communication and cooperation between pilot hospitals and non-pilot hospitals, explore appropriate medical service performance evaluation system and incentive mechanism, mobilize the enthusiasm of personnel, and ensure the rational application of DRGs in hospitals.

Key words: DRGs, Medical service, Medical staff, Investigation and analysis, Performance

Yan Lun. Investigation and analysis of the effect of DRGs on the medical service performance evaluation in public hospitals[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(01): 115-120.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2023.01.027

https://zhshfbwkzz.cma-cmc.com.cn/EN/Y2023/V17/I01/115

Figures/Tables 3

References 21

[1]	新华社. 习近平主持召开中央全面深化改革领导小组第十一次会议李克强等出席[EB/OL]. (2015-04-01)[2021-11-30]. URL
[2]	Baker LC, Lamiraud K. Adoption of hospital diagnosis-related group financing in Switzerland and the availability of computed tomography scanners[J]. Health Economics, 2022, 31(12): 2537-2557.
[3]	杨琰, 白忠良, 周典, 等. 基于DRG的医院科室床位效率分析及配置研究[J]. 中国医院管理, 2022(10): 42.
[4]	国家卫生健康委员会. 2020年我国卫生健康事业发展统计公报[EB/OL]. (2021-07-13)[2021-09-29]. URL
[5]	李培林, 陈光金, 张翼. 2016年中国社会形势分析与预测[M]. 北京: 社会科学文献出版社, 2015: 82-100.
[6]	李毅萍, 杨林朋, 刘新奎. 基于DRG的医院绩效评价管理探讨[J]. 管理学家, 2021(8): 56-58.
[7]	Boes S, Napierala C. Assessment of the introduction of DRG-based reimbursement in Switzerland: Evidence on the short-term effects on length of stay compliance in university hospitals[J]. Health Policy, 2021, 125(6): 739-750.
[8]	Briestensky R, Kljunikov A. The impact of DRG-based management of healthcare facilities on amenable mortality in the European Union[J]. Problems and Perspectives in Management, 2021, 19(2): 264-275.
[9]	方金鸣, 刘玲, 彭义香, 等. DRG支付制度改革中医务人员诊疗行为调查研究[J]. 中国医院管理, 2022, 42(3): 37-42.
[10]	Fahlevi H, Irsyadillah I, Indriani M, et al. DRG-based payment system and management accounting changes in an Indonesian public hospital: exploring potential roles of big data analytics[J]. Journal of Accounting & Organizational Change, 2022, 18(2): 325-345.
[11]	Elgwairi E, Yang S, Nugent K. Association of the All-Patient Refined Diagnosis-Related Groups Severity of Illness and Risk of Mortality Classification with Outcomes[J]. South Med J, 2021, 114(10): 668-674.
[12]	钟茜. 基于DRGs公立医院绩效评价体系的思考与探索[J]. 财经界, 2021(30): 183-184.
[13]	侯明, 肖万超, 刘静, 等. DRG支付改革背景下医院面临的挑战及绩效管理应对策略[J]. 江苏卫生事业管理, 2021, 32(11): 1410-1415.
[14]	Schultz K, Enterline L, Igboechi O, et al. A Review of Price Transparency Policy and Evaluation of Hospital Compliance in Orthopedic Sports Medicine[J]. HSS J, 17(2): 138-144.
[15]	要鹏韬, 杨楠, 马丽, 等. 基于疾病诊断分组的医院人力资源配置公平性与服务能力的初步研究[J]. 中国防痨杂志, 2022, 44(4): 9.
[16]	张学军, 陈咏梅, 李嘉, 等. 医保支付改革背景下的公立医院绩效策略研究[J]. 中国卫生经济, 2022, 8(41): 57-60.
[17]	Aragón MJ, Chalkley M, Kreif N. The long-run effects of diagnosis related group payment on hospital lengths of stay in a publicly funded health care system: Evidence from 15 years of micro data[J]. Health Econ, 2022, 31(6): 956-972.
[18]	王尊晖, 李才学. DRGs运行下的临床医务人员知信行现状调查分析[J]. 中国医院统计, 2022, 29(1): 63-68.
[19]	温美林, 颜涛, 徐飞, 等. 医院DRGs绩效评价指标体系的构建与应用[J]. 中国卫生信息管理杂志, 2022, 6(19): 332-337.
[20]	张达, 高广颖, 田佳帅, 等. 试点地区医务人员CHS-DRG认知水平研究[J]. 中国卫生经济, 2022, 41(4): 5.
[21]	Aktas P. Physician perspectives on the implications of the diagnosis-related groups for medical practice in Turkey: A qualitative study[J]. Int J Health Plann Manage, 2022, 37(3): 1769-1780.

基本情况		人数(%)	患者维度			医生维度			医疗资源维度			总评分
基本情况		人数(%)	评分(±s)	t/F	P	评分(±s)	t/F	P	评分(±s)	t/F	P	评分(±s)	t/F	P
性别	男	122(52.36)	3.41±0.81	0.896	0.371	3.32±0.85	0.694	0.489	3.26±0.96	0.369	0.713	9.99±2.52	0.661	0.509
性别	女	111(47.64)	3.31±0.91	0.896	0.371	3.23±0.98	0.694	0.489	3.22±1.04	0.369	0.713	9.76±2.85	0.661	0.509
收入	满意	88(37.77)	3.85±0.71	7.523	0.001	3.82±0.74	7.838	0.001	3.81±0.80	7.630	0.001	11.48±2.17	7.993	0.001
收入	不满意	145(62.23)	3.07±0.81	7.523	0.001	2.95±0.86	7.838	0.001	2.89±0.94	7.630	0.001	8.91±2.49	7.993	0.001
DRGs试点	是	121(51.93)	3.87±0.59	11.953	0.001	3.73±0.70	9.213	0.001	3.76±0.77	9.908	0.001	11.37±1.96	10.769	0.001
DRGs试点	否	112(48.07)	2.81±0.76	11.953	0.001	2.79±0.87	9.213	0.001	2.68±0.90	9.908	0.001	8.28±2.42	10.769	0.001
DRGs绩效奖惩办法	有	96(41.2)	3.88±0.69	8.749	0.001	3.78±0.78	7.849	0.001	3.79±0.88	8.020	0.001	11.45±2.26	8.545	0.001
DRGs绩效奖惩办法	无	137(58.8)	3.01±0.79	8.749	0.001	2.93±0.84	7.849	0.001	2.85±0.88	8.020	0.001	8.79±2.39	8.545	0.001
问卷用时	低水平	117(50.21)	3.37±0.95	0.143	0.886	3.32±0.97	0.749	0.455	3.34±1.01	1.488	0.138	10.03±2.88	0.852	0.395
问卷用时	高水平	116(49.79)	3.36±0.77	0.143	0.886	3.23±0.86	0.749	0.455	3.14±0.98	1.488	0.138	9.73±2.46	0.852	0.395
婚姻状况	已婚	217(93.13)	3.40±0.85	3.079	0.048	3.31±0.90	2.410	0.092	3.27±0.99	1.868	0.157	9.99±2.64	2.519	0.083
	未婚	11( 4.72)	2.98±1.02			2.82±1.12			2.93±1.07			8.73±3.17
	其他	5( 2.15)	2.65±0.70			2.75±0.87			2.55±0.91			7.95±2.35
身份	劳务	10( 4.29)	3.55±0.64	1.547	0.203	3.50±0.63	1.958	0.121	3.55±0.67	1.475	0.222	10.60±1.92	1.743	0.159
	派遣	16( 6.87)	3.39±0.47			3.41±0.61			3.28±0.64			10.08±1.48
	在编	199(85.41)	3.38±0.87			3.29±0.93			3.25±1.01			9.91±2.72
	其他	8( 3.43)	2.75±1.26			2.56±1.24			2.59±1.30			7.91±3.77
岗位	行政	13( 5.58)	3.87±0.73	5.038	0.002	3.90±0.73	5.471	0.001	3.87±0.76	6.137	0.001	11.63±2.14	5.947	0.001
	护理及其他	9( 3.86)	4.03±0.55			3.92±0.73			4.14±0.72			12.08±1.94
	医技	20( 8.58)	3.65±0.67			3.60±0.67			3.56±0.70			10.81±1.98
	医疗	191(81.97)	3.27±0.87			3.17±0.92			3.12±1.00			9.56±2.70
职称	初级	12( 5.15)	2.94±1.02	2.803	0.063	2.75±1.04	2.476	0.086	2.73±1.01	2.126	0.122	8.42±3.02	2.560	0.080
	中级	83(35.62)	3.27±0.98			3.24±1.08			3.19±1.11			9.70±3.10
	高级	138(59.23)	3.46±0.75			3.35±0.78			3.32±0.91			10.12±2.33
职务	无	177(75.97)	3.26±0.84	6.398	0.002	3.19±0.88	4.926	0.008	3.16±0.95	4.271	0.015	9.60±2.59	5.442	0.005
	中层干部	52(22.32)	3.63±0.84			3.52±0.97			3.45±1.10			10.61±2.78
	院领导	4( 1.72)	4.31±0.77			4.19±0.83			4.31±0.77			12.81±2.35
医疗服务绩效	非常不满意	21(9.01)	2.21±0.77	47.527	0.001	1.90±0.74	54.555	0.001	1.62±0.65	62.565	0.001	5.74±1.84	62.049	0.001
	不满意	27(11.59)	2.59±0.73			2.55±0.83			2.34±0.82			7.48±2.25
	一般	125(53.65)	3.40±0.64			3.29±0.65			3.34±0.67			10.02±1.87
	满意	46(19.74)	3.87±0.56			3.92±0.53			3.85±0.71			11.64±1.69
	非常满意	14( 6.01)	4.63±0.50			4.54±0.63			4.57±0.60			13.73±1.71
学历	本科	98(42.06)	3.04±0.82	18.413	0.001	2.97±0.92	12.878	0.001	2.90±1.00	13.474	0.001	8.91±2.66	15.811	0.001
	硕士	54(23.18)	3.35±0.79			3.29±0.86			3.27±0.87			9.90±2.42
	博士	81(34.76)	3.77±0.79			3.64±0.82			3.64±0.92			11.04±2.42
年龄	20~29岁	8( 3.43)	2.81±1.14	4.629	0.004	2.50±1.12	6.244	0.001	2.59±1.07	3.045	0.030	7.91±3.25	4.759	0.003
	30~39岁	65(27.9)	3.18±0.87			3.03±0.93			3.08±0.94			9.28±2.65
	40~49岁	115(49.36)	3.38±0.82			3.34±0.86			3.27±0.99			9.98±2.57
	≥50岁	45(19.31)	3.70±0.79			3.62±0.86			3.53±1.01			10.85±2.56
工龄	低(≤12年)	74(31.76)	3.11±0.83	7.956	0.001	2.99±0.87	7.956	0.001	3.01±0.90	7.956	0.001	9.11±2.50	6.934	0.001
	中(13~17年)	90(38.63)	3.34±0.84			3.29±0.87			3.23±0.99			9.86±2.59
	高(≥18年)	69(29.61)	3.67±0.84			3.57±0.94			3.51±1.03			10.74±2.75

基本情况		人数(%)	患者维度			医生维度			医疗资源维度			总评分
基本情况		人数(%)	评分(±s)	t/F	P	评分(±s)	t/F	P	评分(±s)	t/F	P	评分(±s)	t/F	P
性别	男	122(52.36)	3.41±0.81	0.896	0.371	3.32±0.85	0.694	0.489	3.26±0.96	0.369	0.713	9.99±2.52	0.661	0.509
性别	女	111(47.64)	3.31±0.91	0.896	0.371	3.23±0.98	0.694	0.489	3.22±1.04	0.369	0.713	9.76±2.85	0.661	0.509
收入	满意	88(37.77)	3.85±0.71	7.523	0.001	3.82±0.74	7.838	0.001	3.81±0.80	7.630	0.001	11.48±2.17	7.993	0.001
收入	不满意	145(62.23)	3.07±0.81	7.523	0.001	2.95±0.86	7.838	0.001	2.89±0.94	7.630	0.001	8.91±2.49	7.993	0.001
DRGs试点	是	121(51.93)	3.87±0.59	11.953	0.001	3.73±0.70	9.213	0.001	3.76±0.77	9.908	0.001	11.37±1.96	10.769	0.001
DRGs试点	否	112(48.07)	2.81±0.76	11.953	0.001	2.79±0.87	9.213	0.001	2.68±0.90	9.908	0.001	8.28±2.42	10.769	0.001
DRGs绩效奖惩办法	有	96(41.2)	3.88±0.69	8.749	0.001	3.78±0.78	7.849	0.001	3.79±0.88	8.020	0.001	11.45±2.26	8.545	0.001
DRGs绩效奖惩办法	无	137(58.8)	3.01±0.79	8.749	0.001	2.93±0.84	7.849	0.001	2.85±0.88	8.020	0.001	8.79±2.39	8.545	0.001
问卷用时	低水平	117(50.21)	3.37±0.95	0.143	0.886	3.32±0.97	0.749	0.455	3.34±1.01	1.488	0.138	10.03±2.88	0.852	0.395
问卷用时	高水平	116(49.79)	3.36±0.77	0.143	0.886	3.23±0.86	0.749	0.455	3.14±0.98	1.488	0.138	9.73±2.46	0.852	0.395
婚姻状况	已婚	217(93.13)	3.40±0.85	3.079	0.048	3.31±0.90	2.410	0.092	3.27±0.99	1.868	0.157	9.99±2.64	2.519	0.083
	未婚	11( 4.72)	2.98±1.02			2.82±1.12			2.93±1.07			8.73±3.17
	其他	5( 2.15)	2.65±0.70			2.75±0.87			2.55±0.91			7.95±2.35
身份	劳务	10( 4.29)	3.55±0.64	1.547	0.203	3.50±0.63	1.958	0.121	3.55±0.67	1.475	0.222	10.60±1.92	1.743	0.159
	派遣	16( 6.87)	3.39±0.47			3.41±0.61			3.28±0.64			10.08±1.48
	在编	199(85.41)	3.38±0.87			3.29±0.93			3.25±1.01			9.91±2.72
	其他	8( 3.43)	2.75±1.26			2.56±1.24			2.59±1.30			7.91±3.77
岗位	行政	13( 5.58)	3.87±0.73	5.038	0.002	3.90±0.73	5.471	0.001	3.87±0.76	6.137	0.001	11.63±2.14	5.947	0.001
	护理及其他	9( 3.86)	4.03±0.55			3.92±0.73			4.14±0.72			12.08±1.94
	医技	20( 8.58)	3.65±0.67			3.60±0.67			3.56±0.70			10.81±1.98
	医疗	191(81.97)	3.27±0.87			3.17±0.92			3.12±1.00			9.56±2.70
职称	初级	12( 5.15)	2.94±1.02	2.803	0.063	2.75±1.04	2.476	0.086	2.73±1.01	2.126	0.122	8.42±3.02	2.560	0.080
	中级	83(35.62)	3.27±0.98			3.24±1.08			3.19±1.11			9.70±3.10
	高级	138(59.23)	3.46±0.75			3.35±0.78			3.32±0.91			10.12±2.33
职务	无	177(75.97)	3.26±0.84	6.398	0.002	3.19±0.88	4.926	0.008	3.16±0.95	4.271	0.015	9.60±2.59	5.442	0.005
	中层干部	52(22.32)	3.63±0.84			3.52±0.97			3.45±1.10			10.61±2.78
	院领导	4( 1.72)	4.31±0.77			4.19±0.83			4.31±0.77			12.81±2.35
医疗服务绩效	非常不满意	21(9.01)	2.21±0.77	47.527	0.001	1.90±0.74	54.555	0.001	1.62±0.65	62.565	0.001	5.74±1.84	62.049	0.001
	不满意	27(11.59)	2.59±0.73			2.55±0.83			2.34±0.82			7.48±2.25
	一般	125(53.65)	3.40±0.64			3.29±0.65			3.34±0.67			10.02±1.87
	满意	46(19.74)	3.87±0.56			3.92±0.53			3.85±0.71			11.64±1.69
	非常满意	14( 6.01)	4.63±0.50			4.54±0.63			4.57±0.60			13.73±1.71
学历	本科	98(42.06)	3.04±0.82	18.413	0.001	2.97±0.92	12.878	0.001	2.90±1.00	13.474	0.001	8.91±2.66	15.811	0.001
	硕士	54(23.18)	3.35±0.79			3.29±0.86			3.27±0.87			9.90±2.42
	博士	81(34.76)	3.77±0.79			3.64±0.82			3.64±0.92			11.04±2.42
年龄	20~29岁	8( 3.43)	2.81±1.14	4.629	0.004	2.50±1.12	6.244	0.001	2.59±1.07	3.045	0.030	7.91±3.25	4.759	0.003
	30~39岁	65(27.9)	3.18±0.87			3.03±0.93			3.08±0.94			9.28±2.65
	40~49岁	115(49.36)	3.38±0.82			3.34±0.86			3.27±0.99			9.98±2.57
	≥50岁	45(19.31)	3.70±0.79			3.62±0.86			3.53±1.01			10.85±2.56
工龄	低(≤12年)	74(31.76)	3.11±0.83	7.956	0.001	2.99±0.87	7.956	0.001	3.01±0.90	7.956	0.001	9.11±2.50	6.934	0.001
	中(13~17年)	90(38.63)	3.34±0.84			3.29±0.87			3.23±0.99			9.86±2.59
	高(≥18年)	69(29.61)	3.67±0.84			3.57±0.94			3.51±1.03			10.74±2.75

维度	Cronbach's α系数	KMO系数
患者	0.714	0.742
医生	0.736	0.759
医院	0.744	0.782
总分	0.754	0.791

维度	Cronbach's α系数	KMO系数
患者	0.714	0.742
医生	0.736	0.759
医院	0.744	0.782
总分	0.754	0.791

变量	层级	β	标准差	卡方值	P	β的95%置信区间
变量	层级	β	标准差	卡方值	P	下限	上限
常数项		5.686	0.928	37.513	0.001	3.867	7.506
收入	否	-0.902	0.254	12.571	0.001	-1.400	-0.403
	是	0.000
试点	否	-1.175	0.268	19.208	0.001	-1.700	-0.650
	是	0.000
DRG绩效奖惩办法	无	-0.601	0.259	5.394	0.020	-1.107	-0.094
	有	0.000
岗位	医疗	-0.130	0.520	0.063	0.802	-1.150	0.889
	医技	0.627	0.617	1.032	0.310	-0.583	1.837
	护理及其他	0.334	0.719	0.216	0.642	-1.075	1.744
	行政	0.000
职务	院领导	0.845	0.884	0.912	0.339	-0.888	2.578
	中层干部	0.107	0.263	0.166	0.684	-0.408	0.623
	无	0.000
学历	博士	0.576	0.260	4.935	0.026	0.068	1.085
	硕士	0.499	0.271	3.406	0.065	-0.031	1.030
	本科	0.000
年龄	≥50岁	1.702	0.606	7.887	0.005	0.514	2.890
	40~49岁	1.267	0.581	4.756	0.029	0.128	2.405
	30~39岁	1.233	0.604	4.166	0.041	0.049	2.416
	20~29岁	0.000
工龄	低(≤12年)	0.127	0.349	0.133	0.716	-0.557	0.811
	中(13~17年)	0.478	0.294	2.637	0.104	-0.099	1.055
	高(≥18年)	0.000
医疗服务绩效评价		1.271	0.133	90.810	0.001	1.010	1.533

Please choose a citation manager

Content to export