Analysis Of Medical Service Quality And Performance Under The DRG Payment Management Mode Of A Large Grade A Tertiary Hospital

Background and Objective:With the rapid development of the global economy and society and the continuous improvement of living standards,people’s demand for health is getting higher and higher,but the problem of population aging is also intensifying.Reasonable and effective control of the growth of medical expenses has become an urgent problem for various countries to solve.The participation rate of my country’s basic medical insurance has been stabilized at more than 95%,which means that the growth of medical insurance fund income will slow down,but the expenditure of medical insurance expenses is growing rapidly and the scale of my country’s aging population has far exceeded that of the aging society standard.It is against this background that DRG came into being.Our country has been studying how to use it to reform medical insurance payment methods.With the continuous improvement of medical insurance policies,all hospitalized patients are basically converted into medical insurance patients.The medical insurance department pays medical institutions according to the fee standard of the patient’s entry into the diagnosis-related group.Therefore,the practical application of DRG in modern hospital management becomes very important.Based on the background of DRG payment reform in China,this study discusses the actual implementation effect of DRG in hospitals by analyzing the quality and performance of medical services in a Grade A tertiary hospital in Shenzhen.It is expected that this study will provide reference for the promotion and implementation of DRG in China,and also provide ideas for the reform of medical insurance payment methods of medical insurance management departments and medical institutions in China.Methods:By logging into the Shenzhen C-DRG regional grouping management system and the hospital’s DRG comprehensive evaluation management system,you can query the statistical sample hospital DRG upload,enrollment and performance assessment.The data on the homepage of inpatient medical records comes from the medical record management system of medical institutions in Guangdong Province.The medical record data does not include the patient’s name,occupation and home address,etc.,nor does it involve the patient’s personal privacy.The collected sample hospital patient data was established through Excel 2016 to establish a database,and the statistical software SPSS 22.0 was used for statistical analysis.The analysis of the uploading and enrollment of medical records based on C-DRG was performed to compare the results by χ2 test,and the performance evaluation analysis based on CN-DRG was analyzed by the comprehensive index method.Results:Based on C-DRG’s medical record upload and enrollment,the sample hospitals uploaded a total of 42,304 medical records in the second half of 2019,with a pass rate of 98.61%,and uploaded a total of 51,022 medical records in the second half of 2021,with a pass rate of 99.89%.In 2021,the pass rate of the first page of medical records will be significantly improved compared with that in 2019,by performing the χ2 test on the number of cases twice,P<0.05,the difference is statistically significant.The main problems affecting the upload of medical records are the verification of the scope of surgical operations,the verification of the scope of diagnosis,the verification of the number of days in hospital,the verification of codes for non-major surgical operations,and the verification of age etc.In the second half of 2019,39,212 cases were successfully grouped,with an enrollment rate of 94.00%.In the second half of 2021,48,846 cases were successfully grouped,with an enrollment rate of 95.84%and an increase of 1.84%,by performing the x2 test on the number of cases twice,P<0.05,the difference is statistically significant.The main reasons why the cases could not be included in the group were the failure to correctly select the main diagnosis or the main operation and the mismatch between the main diagnosis and the main operation.At the same time,C-DRG also had the problem of the defect of the enrollment rules,which led to the failure of normal enrollment of the cases.The basic medical service capacity of the sample hospitals in the first half of 2021 is overall improved compared with the first half of 2019.Through statistical analysis of 10 representative diseases of the sample hospitals in the first half of 2021 and the first half of 2019,it was found that except for the two diseases of cesarean section and chronic obstructive pulmonary disease,the average hospitalization days and the average cost per case increased,the average hospitalization days and the average cost per case of the other 8 diseases decreased;except for the 5 diseases whose case fatality rate has been 0 for two years,the case fatality rate of the other 5 diseases has decreased,and the case fatality rate of heart failure has decreased the most.Overall,the quality control of single disease is beneficial to improving the quality of medical care.According to the six national monitoring indicators for performance evaluation extracted from the homepage,in the first half of 2021 compared with the first half of 2019,the proportion of inpatient surgeries,the proportion of inpatient fourth-level surgeries,and the proportion of inpatient minimally invasive surgeries all increased;the incidence of surgical complication rate and type I incision surgical site infection rate decreased,among them,the surgical site infection rate of type I incision has been reduced to 0,and the mortality rate of the low-risk group has remained at 0.Based on the CN-DRG performance evaluation of the whole hospital,compared with the first half of 2019,the number of enrolled cases,the total weight of DRG,and the time consumption index in the first half of 2021 are improving;the number of diagnosis-related groups and the cost consumption index decreased slightly,and the low-risk mortality rate remained at zero.The performance evaluation of the four representative departments is basically improving.The comprehensive index method is used to evaluate the medical service level of each department from different dimensions.In the first half of 2019,the rankings are Cardiology 1,Cardiology 2,Gynecology 2,Gynecology 1,and in the first half of 2021,Cardiology 1,Cardio 2,Gynecology 1,Gynecology 2.Conclusions:On the whole,the DRG implementation of the sample hospitals is relatively good,but there is still room for improvement.The medical record upload and enrollment of the sample hospital are good,the standardization of filling in the first page of the medical record,whether the main diagnosis and main operation are correctly selected,and whether the enrollment rules are perfect and other factors affect the successful upload of the medical record and the normal enrollment.The performance evaluation of the sample hospitals is good,and the ability to provide medical services is improving.The application of the performance evaluation based on DRG can intuitively evaluate the medical service level of the department,find out the weak points and improve the department’s ability.