The Application Of DRGs In The Performance Evaluation Of Obstetric Clinical Service

Objective:This study used existing conditions to achieve a more objective and superior DRGs for pregnant and parturient women.To explore whether the new data index can be used,for instance CMI index,cost index,and time index,which used in hospital performance evaluation of medical service differences between different departments to assure clearly which one is better than other one,and advantages and disadvantages of various specialized wards in the medical service?diagnosis and treatment position.At the same time,it also provides data support for hospital administrative planning,monitoring of health care quality and hospital internal budget.Materials and methods:Firstly,using the Delphi method and literature research method,through the communication with clinical obstetrics and Gynecology experts generating different scoring for clinical diagnosis by severe of diseases.For diseases of uncertainty through the literature to determine the final form of severe complication diagnosis items,we establish DRGs model of pregnancy.The group evaluation index R and CV(coefficient of variation)were used to evaluate.Then a database of medical records database was set up by the information of the first page of medical records of a tertiary medical institution from2012 to2015.The data in the database is grouped by the established DRGs grouping model.We analyzed the difference between understanding and comparison of three transverse sections of the medical service ability,ability to test different divisions of resource use differences,changes in longitudinal comparison in the three department.The changes in the rate of cesarean section of pregnant in women were compared and analyzed in detail in other areas and countries.Results: The difference between the groups was statistically significant by using the variance analysis.The p<0.01 calculated R2 was 0.5322,and the average coefficient of variation(CV)of each group was 0.5204,which was less than 1.Finally,it is divided into fourteen groups.We finding the diseases of A,B,C departments in the medical institutions is grouped by DRGs,because of dilution of low index cases resulted in sections of total CMI index was low,in B department of patients with severe diseases were more dominant relative to the other two departments After grouping by DRGs,all the different DRGs have their own hospitalization time and average hospitalization expenses.After using DRGs,we found that all different DRGs had their own hospital time and average hospitalization expenses,and the heavier the complication is,the longer the hospitalization time is,the higher the hospitalization expenses.We calculate the cost and time consumption index of A,B,C according to the formula,the average cost efficiency index of the A department was 1.0158 > 1 higher than the average,and the average time efficiency index of the C department was 1.0996 > 1 higher than the average level.The C department belongs to an inefficient section from 2012 to 2014 in three years.In the analysis of cesarean section rate,the overall cesarean section rate of all three departments is higher than that of Beijing area.The A department is more than the other two departments in the cesarean section without complications.Conclusion: This study explored new solution basing of version of BJ-DRGs combined with the USA DRGs classification method by grouping DRGs for all diseases during pregnancy,childbirth and puerperal period in gynecology and obstetrics department.We evaluate the difficulty for the new exploration using of DRGs disease management evaluation system,the case mix index(CMI)and cost efficiency index,time efficiency index for different departments within the same category and severity of similar disease,which is used in the hospital management evaluation of hospital internal department medical service level,guiding the management for effective management,putting forward to solve the problems of hospital department performance evaluation method over the years.