| Objective:(1)To evaluate the effect of DRGs grouping on the first page data of medical records of discharged patients in Shanxi F hospital.(2)The differences between traditional indicators and DRGs indicators in the performance evaluation of comprehensive medical services were analyzed.(3)To explore the application value of DRGs in the performance evaluation of medical services in the treatment groups.Methods:(1)According to the number of discharged patients,the study samples of eight departments from F hospital were selected by stratified random sampling method,and the data of the first page of medical records from June 1,2018,to May 31,2019,were extracted and conducted DRGs grouping.(2)The coefficient of variation,Reduction in Variance,and ROC curve were used to evaluate the grouping effect of DRGs.(3)The DRGs and traditional performance evaluation indexes of serviceability,medical efficiency,and safety were extracted,respectively.The weight of evaluation indexes was determined by the method of the coefficient of variation,and the results of comprehensive medical service performance evaluation of the two indexes were calculated by the method of non-integer rank and ratio(RSR).(4)The data is sorted and summarized in the Excel table.SPSS 22.0 and SAS 9.4 software are used for data processing and analysis.Variance analysis is used for comparison of multiple groups of means.SNK-q test is used for comparison after the event.The test level is ?=0.05.Results:(1)Among 11,071 cases of the first page of the medical records extracted from eight departments were included in the study,10,931 cases of qualified were grouped into DRGs,with the enrollment rate is 98.74%;all the enrolled cases were divided into 368 DRGs,and RM11 A has the most significant number of enrolled cases(550);207 DRGs were less than 10 cases,with a total of 679 cases,accounting for6.21% of the total enrollment;there are 25 treatment groups in eight departments,including 15 surgical and 10 internal medicine groups.(2)Among the 161 DRGs groups with more than 10 cases in the group,147 and150 DRGs groups of hospital stays and hospital costs with CV<0.8,accounting for91.30% and 93.17% of the total respectively.After grouping,most of the DRGs had less intra-class heterogeneity and better grouping effect.Among the 15 MDC groups,12 MDC groups have RIV values beyond 40%,and the inter-group variation is at a high level;the analysis of the overall inter-group heterogeneity of 161 DRGs groups shows that 71.43% of the total variation can be explained by the inter-group variation,with firm inter-group heterogeneity and better grouping effect.Among the 29 ADRGs groups,25 ADRGs had a significant difference in the ROC curve of hospital costs(P<0.05).Most of the groups in ADRGs had reasonable cut-off value and a good grouping effect.(3)The results of the comprehensive performance evaluation of surgical treatment groups showed that there were significant differences between traditional indicators and DRGs indicators.The difference was the largest in the SW3 group,with RSR ranking rising by 9 from 14 th to 5th,followed by the YK1,falling by 6,and PW1 group ranking unchanged.There was slightly different in the comprehensive performance evaluation results of traditional indicators and DRGs indicators in the internal medical treatment groups.The ranking of RSR value in the XN2 group changed the most and increased by4,and there was no change in the ranking of RSR value in XN1 and XN3 groups.(4)In the surgical treatment groups with noticeable sequence differences,the total weight of the treatment group corresponding to different RSR intervals was significantly different(F=17.27,P<0.05).The different RSR intervals corresponding to the discharged patients of the treatment group,there was no statistically significant difference(F=3.01,P=0.088).However,the number of discharges were adjusted by the CMI value,and there is the significant difference among three groups(F=6.79,P<0.05),suggesting that the adjusted number of discharge patients was consistent with the total weight in the aspect of evaluating the output of medical services,CMI is the main factor that causes the difference between the results of comprehensive performance evaluation of traditional indicators and DRGs indicators.Conclusion:(1)The DRGs grouping effect of the first page of medical records included in the study was better,which can provide accurate data support for the medical service performance evaluation of the treatment groups.(2)There is a certain difference between the traditional indicators and DRGs indicators in the comprehensive performance evaluation of medical services,especially in the surgical treatment groups.(3)CMI is the main factor that results in the difference between the comprehensive performance evaluation results of traditional indicators and DRGs indicators.(4)Compared with traditional indicators,DRGs indicators have more advantages in comparability and scientificity of medical service performance evaluation. |
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