| Objectives: Through combing case area DRG pricing and payment system reform background and implementation plan,with respiratory disease surgical diagnosis and treatment of DRG group patients as the research object,compared the changes of non-surgical treatment group of respiratory diseases before and after the implementation of DRG pricing and payment reform,summarized the problems and experience,and provided suggestions and reference for further promoting the reform of DRG collection and payment in Y City.Methods: This study collected the homepage data of inpatient records in the non-surgical treatment group of respiratory diseases from January 1,2017 to December 31,2020.Through general description statistics,test,chi-square test and intermittent time series model,the changes of non-surgical treatment group after the implementation of DRG were compared from six dimensions: service capacity,service efficiency,cost control,medical record management,quality safety,and quality evaluation of respiratory medicine specialty.Results: 1.Service capability.The number of DRG groups covered by pilot hospitals in the case area increased from 657 in 2017 to 721 in 2020,and the number of basic groups increased from 338 to 371.In the non-surgical diagnosis and treatment group of respiratory diseases,the number of inpatient diseases in pilot hospitals increased from 225 in 2017 to 243 in 2020,and the number of inpatient operations increased from 161 to 178 in 2020;the Case-mix index(CMI)increased from 0.95 in 2017 to 1.15 in 2020(P <0.05);the total weight in 2019 was 24884.58,up 8.55% from 2017.2.Service efficiency.(1)Time consumption index.Since the pilot hospital officially implemented the DRG pricing and payment reform in 2018,the time consumption index of the non-surgical diagnosis and treatment group of respiratory diseases in tertiary hospitals has decreased from 1.06 before implementation to 0.99 in2020;and secondary hospitals increased from 0.98 to 0.99.(2)Resource consumption index.The resource consumption index of tertiary hospitals decreased from 1.19 to1.15.(3)Average hospitalization days.In 2017-2020,the starting level of average hospitalization days before the reform of the tertiary pilot hospitals was 9.73 days,and the average hospitalization days increased by 0.19 days after the intervention,which was significantly different from the original downward trend;The starting level of the secondary hospital is 6.10 days,and the other variables were meaningless.3.Cost control.(1)Average hospitalization cost.The average hospitalization cost of the non-surgical diagnosis and treatment group for respiratory diseases in the tertiary pilot hospitals was reduced from 6008.56 yuan to 4025.93 yuan in 2019 and the average hospitalization cost of secondary pilot hospitals decreased from 3692.94 yuan to 3263.71 yuan in 2019.(2)In 2017-2020,the level of hospitalization costs of patients in the non-surgical diagnosis and treatment groups of respiratory diseases in the pilot hospitals fluctuated greatly with different months.The initial level of per capita hospitalization expenses of the second-level pilot hospitals before the reform was 2395.275 yuan,and the downward trend of the hospitalization expenses in the first month after the reform increased by 1394.749 yuan.Compared with the original upward trend,significant changes have taken place,the cost of hospitalization is significantly lower than before the reform;Before the reform of tertiary pilot hospitals,the initial level of per capita hospitalization cost was 7871.879 yuan,and the t coefficient was-173.70,indicating that before the intervention,that is,before 2018,the hospitalization expenses decreased by-173.70 yuan per year(P <0.011,95%CI=[306.14,41.25]).After the intervention,the hospitalization expenses increased by281.93 yuan,a significant change from the original downward trend.(3)Composition ratio of hospitalization expenses.In 2017-2020,the proportion of drugs,consumables and other expenses in the hospitalization expenses of non-surgical diagnosis and treatment groups of respiratory diseases in pilot hospitals after the DRG pricing and payment reform showed a downward trend,decreasing by 7.31%,21.19% and16.66% respectively.The proportion of inspection and inspection showed an upward trend,with a growth rate of 26.10%.4.Medical record management.After the implementation of DRG pricing and payment,the enrollment rate of non-surgical treatment of respiratory diseases increased from 69.63% in 2018 to 93.29% in 2020,and the settlement rate increased from 97.49% in 2018 to 99.12% in 2020,showing a trend of increasing year by year,reflecting the improvement of the DRG group of non-surgical treatment of respiratory diseases.5.Quality and safety.After intervention,the case mortality and nosocomial infection rate of the low-risk group in the non-surgical treatment group of respiratory diseases in pilot hospitals showed a decreasing trend,which was lower than that before the reform(P <0.01).6.Specialty quality in respiratory medicine.After the DRG reform,the in-hospital mortality rate of patients with acute COPD exacerbation and the in-hospital proportion of patients with low-risk community-acquired pneumonia in the non-surgical treatment group of respiratory diseases in pilot hospitals remained basically unchanged,0.52% and 0.49%,respectively,with no statistical significance(P >0.05).Conclusions: This study is based on the change of DRG group for non-surgical diagnosis and treatment of respiratory diseases in pilot hospitals before and after the implementation of DRG collection and payment reform in pilot hospitals in the case area.The main conclusions are as follows:First,the case area since 2012 continued to pay by the project,according to disease price payment,CN-DRG pricing and payment reform,in the security of medical insurance fund use safety and efficiency,control unreasonable medical expenses growth,improve the quality of hospital record fill in the aspects has obtained certain effect,for the subsequent comprehensive implementation by DRG pricing and payment reform laid a foundation.In addition,the case area adheres to the system reform plan with the integration as the point: covering all hospitals in the region and reducing the change of patient flow;covering all hospitalized patients and avoiding the comparison among patients with different types of payment methods;covering all types of medical insurance to facilitate the unified supervision of medical insurance agencies.Second,the reform of DRG pricing and payment reform has different effects on the non-surgical treatment groups of respiratory diseases in different levels of pilot hospitals.Therefore,in order to promote the DRG pricing and payment reform in the case area in the future,reasonably allocate medical resources,effectively control medical costs,and reduce the burden of medical treatment for patients,the following suggestions are put forward: first,strengthen the top-level design and establish an efficient cross-departmental communication and cooperation mechanism;Second,accelerate the establishment of unified information support standards;Third,the establishment of supporting supervision measures;Fourth,continue to strengthen clinical quality and safety management. |
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