Research On The Evaluation Index System Of Medical Service Of The Attending Groups Under DRG Management

Objective:This study is based on the management idea of DRG and the perspective of clinical big data analysis.According to the national reform measures to promote DRG payment,the research object is "main physician group",which is the core unit of medical service supply side.Combined with the hot spots of new medical reform and the actual hospital management,it constructs a DRG index based,traditional medical quality,medical performance evaluation index as a supplement to the evaluation index system of the medical service of the primary physician group,sort out the problems and blind spots faced in the implementation of the responsibility system of the primary physician,clarify the key role of DRG index in the evaluation of the medical service of the primary physician group,and provide a scientific path for the evaluation and management of the primary physician group,aiming to use the index evaluation results to accurately implement policies and mobilize the initiative of doctors at all levels With enthusiasm,we should standardize and restrict the behaviors of diagnosis and treatment,realize the"double promotion" of medical quality and medical performance,strengthen the core competitiveness and brand building within the group,and explore a new mode of sub specialty cooperation and development.Methods:1.Literature researchThrough the comprehensive medical database,Chinese database and grey literature query,we can comprehensively search the domestic and foreign literatures,such as the application of DRG in hospital management and medical service evaluation,sort out and analyze the management practice trends and development trends of DRG,understand the current medical performance,quality and other medical service evaluation indicators,and master the calculation of DRG medical service evaluation indicators.2.Delphi experts consultation methodAfter the preliminary formulation of the index system and the completion of the questionnaire pre survey,19 administrative management experts and clinical experts with rich experience in hospital management were invited as the objects of consultation,and Delphi method was used to carry out three rounds of expert correspondence.According to the principles of scientificity,hierarchy and representativeness,the relevant dimensions,index adaptability and operability of the preliminary formulation of the index system were adjusted and modified And evaluate the familiarity and authority of the experts until the experts' opinions tend to be unified gradually,forming the final index system structure.3.Analytic hierarchy processIn this study,AHP is used to make target decision and index weight,and the first,second and third index weight of the index system and the combined weight of the whole medical service evaluation index system are determined through four steps:establishing hierarchical structure,constructing pairwise comparison judgment matrix,calculating the weight of alternative elements,and conducting consistency test.4.Empirical research methodUsing the index system established in this study,six diagnosis and treatment groups in the sample hospital were evaluated empirically.The performance of each group in DRG medical service index score was analyzed through clinical big data refinement,and a comprehensive comparison was made.Result:1.Establish "the evaluation index system of medical service of the main physician group under the DRG management idea"Based on the flat management concept of matrix organization in modern hospital management system,combined with the characteristics and advantages of disease diagnosis related groups,this study developed a medical service evaluation index system for the chief physician group,which includes four primary indexes,12 secondary indexes,49 tertiary indexes,covering four internationally recognized medical quality,medical performance,discipline construction and medical safety Important dimensions of medical service evaluation.19 hospital management and clinical experts were contacted for three rounds of consultation and demonstration.The recovery rate of each round of questionnaire was 100%,and the experts had a high enthusiasm for participation.The authority coefficient of experts was 0.857,and the familiarity coefficient was 0.849,indicating that the experts had a high authority in the industry and a unified opinion coordination(the coordination coefficient was 0.488,?2=223.471,P<0.001).Two indexes were deleted and one index was added in the correspondence 2 indicators are corrected.2.Determine the index weight of each layer and the combination weight of index systemUsing AHP to calculate the weight of each layer of indicators in the "evaluation index system of medical service of the main group of doctors under DRG management",the weight of medical quality indicators is 0.281,the weight of medical performance indicators is 0.438,the weight of discipline construction indicators is 0.106,and the weight of medical safety indicators is 0.175.Among them,the final quality of secondary indicators is the key link of medical quality evaluation;the service ability,operation efficiency and income and expenditure structure of secondary indicators are the important influencing factors of medical performance evaluation;the development of secondary indicators is the outstanding performance of discipline construction achievements;the patient safety of secondary indicators is the decisive factor of medical safety;at the same time,the weight of seven DRG indicators refers to this level The weight of the standard is the highest,which shows the importance and dominance of DRG index in evaluating medical services.3.Empirical research results of indicator systemBased on the six main diagnosis groups of hepatobiliary department I and hepatobiliary Department II,which have the same diagnosis and treatment level,similar medical resources and similar number of patients in a large-scale top three public hospital in Guangdong Province,this paper makes an empirical study on the evaluation system of this index:extracting the information and medical related data of the front page of the medical records of six main diagnosis groups in 2019,and grouping the front page of the medical records by CN-DRGs(2014 version)to the two departments Six groups of chief physicians in the Department were evaluated for medical service.The results showed that group E and group C were the best of the six groups.(1)in terms of DRG service ability index,the number of DRG treatment groups in Group E was the highest,with 77 groups.The CMI value of the whole group(case combination index)was 1.65,far exceeding the hospital average level of 1.38,indicating that although the overall treatment of patients in this group was complex and difficult,the treatment ability was strong and the technical water was strong The rate of DRG in group C was the highest(73.34%),and the effect of DRG coverage was better.(2)In terms of DRG service efficiency,the time consumption index of the C main diagnosis group in the first Department of hepatobiliary is 0.69,the average length of stay after CMI correction is the shortest,and the CMI value of the C main diagnosis group is 1.54,indicating that the resource utilization rate of the C main diagnosis group remains stable under the premise of high level of treatment technology difficulty,and the medical resource utilization is the best among the 6 main diagnosis groups.(3)In terms of discipline construction,there are only four kinds of DRG diseases in the top ten diseases in the six main treatment groups,and the rest are DRG diseases in the low and medium risk groups,which indicates that relevant departments and main treatment groups should strengthen the treatment of high and medium high risk groups and optimize the disease structure.(4)In terms of medical safety,the mortality rate in the low-risk group of patients in the six main diagnosis groups was 0;in 2019,one death case in the low-risk group occurred in the B main diagnosis group,which increased the mortality rate in the low-risk group to 0.08%,and the mortality rate in the other five groups in the low-risk group was 0.Conclusions:1.Using DRG management indicators to evaluate the medical services of the chief physicians under the department director responsibility system is a beneficial attempt to actively adapt to the competitive pattern under DRG payment mode,enriching the three-level evaluation system of "hospital department diagnosis and treatment group".At the same time,using the evaluation results to assess,mobilizing the active participation and enthusiasm of clinical medical personnel,improving the department management mechanism The system enlivens the medical resource stock of the Department.2.To explore the value and opportunity brought by the main diagnosis group to the construction and development of the sub specialty under the DRG management idea has certain timeliness and practicability,which has practical reference significance for the decision-making level of the health department and the hospital management activities,and also provides new ideas for the multi-dimensional evaluation and multi-disciplinary development of different sub specialty diagnosis and treatment groups.3.In fact,the implementation of the chief physician group is also a process from specialized management to disease management,which takes into account the multi-level medical needs of patients.To enlarge the guiding role of DRG indicators and refine the disease evaluation to the individual doctors has obvious effect on gradually adjusting the disease treatment structure and weakening the dilution of light disease on the Department operation performance,but at the same time,there may be some phenomena such as reducing the service volume and shirking responsibility for patients.Based on the top-level design of DRG reform,we should also pay attention to this long-term and important question in the operation process of the main doctor group Question.In order to establish a value-oriented medical service evaluation system,this study puts forward three ideas:(1)To build a balanced ecological group system of the main diagnosis group,to formulate strategies for the differential development of the main diagnosis group,so that the members of the main diagnosis group can share the achievements of reform and development;(2)The hospital should explore the establishment of DRG led clinical big data decision-making center and use information tools to drive the reform of clinical diagnosis and treatment;(3)Actively expand the grasp and power of hospital management innovation,explore a new path of medical service homogenization management,and improve management efficiency.(4)We should strengthen the emergency management of the chief physician group under the public health emergencies,and take the labor performance distribution of the medical staff in the post epidemic era as the focus of the hospital health economic work in the future.