An Empirical Study Of The Relationship Between Clinical Pathways And DRG In Public Hospitals

Objective: In the context of high-quality development of public hospitals,hospitals need to pay attention to both medical quality and control medical costs,and the relationship and mutual adaptability of clinical pathways and DRG(Diagnosis Related Groups,DRG)have become the focus of research in the medical field.In order to investigate the mutual relationship and adaptability of clinical pathways and DRG,this study combines relevant indicators to build an evaluation index system of the development level of clinical pathways and DRG,analyze their development level and change trend,and then build a relevant model to analyze their causal link and dynamic relationship.On this basis,we further study the coupling degree and coordination level between clinical pathways and DRG system of each department under different stages,and analyze their mutual adaptation degree,so as to provide reference for optimizing clinical pathway management,improving DRG system,and promoting the common development of clinical pathways and DRG.Methods: Based on the analysis of domestic and foreign literature,we understood the development of clinical pathways and DRG,evaluation indexes,etc.,initially constructed the framework of index system,modified and improved the evaluation index system of clinical pathways and DRG development level by expert consultation method,collected data and used entropy weighting method to assign weight to the index system and obtained the development level and change trend of clinical pathways and DRG.On this basis,the panel vector auto-regression(PVAR)model was further constructed to analyze the causal relationship and dynamic connection between clinical pathways and DRG,and then the coupling coordination degree model was used to study the coupling degree of clinical pathways and DRG system and the coupling coordination degree to determine whether they can adapt to each other Then,the coupling coordination model was used to study the coupling degree and coupling coordination degree of clinical pathways and DRG system to determine whether they can adapt to each other and the degree of adaptation.Results:(1)In this study,two rounds of expert consultation were conducted,the positive coefficient of experts were 100%,the authority coefficient of experts were 0.83,and the p-value of Kendall’s coordination coefficient were statistically significant.The final evaluation index system of clinical pathway development level includes: 3 primary indexes and 14 secondary indexes;the evaluation index system of DRG development level includes: 3 primary indexes and 19 secondary indexes.(2)Clinical pathway and DRG development level: the overall development level of clinical pathway of 9departments is low and changing,and the gap between different departments is large;the development index of obstetrics and gynecology,general surgery,pediatrics and orthopedics is at a high level,cardiovascular medicine is in the middle position,and the development level of oncology,respiratory medicine,infection and cardiac macrovascular is low;the development index of DRG of 9 departments in 2021-2022 changes The development index of DRG in 2021-2022 is significantly higher than that in 2022,and the overall development index is significantly lower than that of the clinical pathway,and the difference between different departments is large,and the development index of cardiac vascular,general surgery and orthopedics is significantly higher than that of other departments in 2021-2022.(3)The development of clinical pathway is less dependent on time coherence,the development of DRG itself has a certain path dependence,the development of DRG effectively promotes the development of clinical pathway,the development of clinical pathway does not significantly promote the development of DRG,DRG is the Granger cause of clinical pathway,clinical pathway is not the cause of DRG.(4)Coupling degree and coordination level of clinical pathway and DRG: The coupling degree and coupling coordination level of the overall development level of clinical pathway and DRG during2021-2022 is relatively smooth,the coupling degree tends to 1,and the coupling coordination degree is between 0.6 and 0.7,which is in the primary coordination stage with weak adaptability.The average coupling coordination degree of orthopedics and general surgery was between 0.7-0.8 in two years,which was in the intermediate coordination stage with better adaptation.The coupling coordination of other departments was between 0.6-0.7 in the primary coordination stage with poor adaptation.Conclusions: The development level of clinical pathway and DRG is low and changes significantly over time;DRG is almost not influenced by clinical pathway,the development of clinical pathway will be influenced by DRG,the influence of clinical pathway and DRG is unidirectional;the overall coupling degree of clinical pathway and DRG is good,the relationship is relatively close,the degree of adaptation of clinical pathway and DRG in different departments changes over time,and most departments have low adaptation ability..The common development of clinical pathway and DRG needs to do the following:(1)improve the service ability and effect to enhance the development of clinical pathway and DRG.(2)Multi-party cooperation to strengthen the dynamic link between clinical pathways and DRG.(3)To improve the degree of adaptation of clinical pathways and DRG in conjunction with actual practice.