Research On Performance Optimization Of Inpatient Medical Services In County-Level General Hospitals

Promoting the comprehensive reform of county-level public hospitals is the top priority of deepening the reform of medical and health system at this stage,and county-level public general hospitals are the "vanguard" responsible for building high-quality medical service system,improving medical technology radiation and optimizing medical service value chain.It is urgent and important to improve its medical service level,and it is necessary to fully grasp its own advantages and disadvantages,and reform self-examination in a targeted manner to promote high-quality construction.Based on this background,this paper explores the present situation and development trend characteristics of inpatient medical service performance in county-level public general hospitals,so as to provide reference for policy practice to build appropriate governance structure and seek the path of inpatient medical services performance optimization.This study summarizes and analyzes the research status,related concepts and classical theories at home and abroad,analyzes the importance of inpatient medical service performance evaluation in county-level public general hospitals,and analyzes the impact of relevant policy logic on it,and then discusses the index selection and significance of inpatient medical service performance evaluation system.At the same time,based on the extensive application of Diagnosis Related Groups(DRG)in hospital management and evaluation,this paper analyzes the connotation,function and advantage mechanism of DRG index system in evaluating inpatient medical service performance.Following this theoretical analysis,X hospital is selected as the research object,and an empirical analysis of the performance evaluation of inpatient medical services is carried out using the DRG index system of Guangdong Province.The statistics show that in terms of service output in X Hospital from 2017 to 2019,the MDC patients met the coverage requirements,the proportion of MDC cases was relatively stable,and the proportion of cases with relative weight(RW value)greater than or equal to 1.5 in DRG group was about 10%.In terms of inpatient medical service capacity,the total weight of DRG is increasing year by year,but the case combination index(CMI)is decreasing year by year,which is a typical model of "scale and quantity".In terms of service efficiency,the cost consumption index is decreasing,and the time consumption index is increasing year by year,which is a high-efficiency hospital in the same category of hospitals in the province.In terms of medical safety,the mortality rate of low-risk group and high-risk group showed a downward trend.Comprehensive performance evaluation shows that the comprehensive performance score ranked first in2018(excellent),second in 2019(good)and last in 2017(good).Empirical analysis shows that X Hospital is facing problems such as structural imbalance in inpatient medical service capacity,unbalanced service efficiency management and coordination,inadequate standardized management of inpatient risks,and difficulty in sustaining the comprehensive efficiency of inpatient medical services.It is necessary to explore and construct an optimized path for quality improvement based on the reasons for focusing on "quantity" and ignoring low-value output governance,lack of high-quality medical resources,lack of service efficiency coordination mechanism and monitoring auxiliary functions,imperfect medical safety management and control mechanism,and lax implementation of the system.Through the study,it is found that in order to meet the health needs of people in the county,county-level public general hospitals should pursue the goal proposition of "fairness and accessibility,people benefit" and "serious illness can’t leave the county" under the guidance of public value of health policy.The establishment of DRG index system can effectively provide an objective evaluation framework for the analysis of inpatient medical services performance in county-level public general hospitals,and it is also a feedback response to provide evidence-based basis for hospital management.To formulate the countermeasures for optimizing the performance of inpatient medical services in county-level public general hospitals,it is necessary to realize collaborative drive in the multi-center governance mode of government,hospitals,social organization structure,etc.The government needs to strengthen the performance evaluation of inpatient medical services,break the bottleneck of hierarchical diagnosis and treatment,and implement a precise compensation mechanism;hospitals must optimize the performance value of inpatient medical services,accelerate the balanced development of clinical specialties,establish a long-term mechanism for sustainable management and control of medical safety,and improve A refined mechanism for performance target assessment;in terms of social organizational structure,it is necessary to strengthen the orderly coordination of participation and build a multiple supervision and incentive mechanism.By complementing and winning with each other,we can break through the institutional rigidity and traditional management dilemma,promote the effective quality improvement and public welfare empowerment of inpatient medical service performance of county-level public general hospitals,and give play to the leading role in county demonstration.