| Objective: In this study,we conducted a field survey to grasp the current situation and problems of implementing the reform of payment by type for appropriate technologies and advantageous diseases in TCM in Guizhou Province,compared the awareness of the reform among relevant medical personnel in pilot and non-pilot hospitals,and studied the factors influencing the feasibility of the implementation of the reform and the factors influencing the behavior of filling out the first page of TCM cases from the perspective of clinicians,which is particularly important for optimizing the quality of the first page of TCM cases and building a medical insurance payment method in line with TCM in the future.This is particularly important for optimizing the quality of TCM case pages and building a medical insurance payment method that meets the characteristics of TCM.In addition,the analysis of the overall factors influencing the implementation of the reform in the future from the perspective of the medical staff of the pilot hospitals can identify the problems of the reform in time and propose countermeasures to promote the reform of the appropriate technology of TCM and the advantageous disease types according to the type of payment in Guizhou Province,and provide decision-making ideas to promote the comprehensive implementation of the reform in the province.Methods:The literature combing method was used to understand the current status of implementation and the solutions to the problems of the reform of payment by disease type for TCM advantageous diseases under the reform of China’s health insurance payment method;the field questionnaire method was used in combination with the interview method to investigate the current status and perception of the implementation of the reform of payment by disease type for TCM appropriate technology and advantageous diseases in Guizhou Province.Purposive sampling method was used to select relevant managers of medical insurance bureaus and medical institutions in the reform pilot areas for individual in-depth interviews and focus group interviews with TCM clinical experts in non-pilot medical institutions;simple random sampling method was used to select relevant medical personnel from the reform pilot and non-pilot hospitals for on-site questionnaire surveys.The data were double-entered with Epi Data 3.1,and SPSS 20.0 and Excel 2010 were used for-site survey data and information.Based on the survey data of clinicians and medical staff of related departments in the reform pilot hospitals,logistic regression models were used to explore the factors influencing the feasibility of reform implementation and the factors influencing the behavioral norms of filling out the first page of TCM cases from the perspective of clinicians and the overall factors influencing the implementation of future reforms from the perspective of medical staff in the pilot hospitals,which were statistically significant at P<0.05.Through a combination of comparative study and correlation analysis,countermeasures and suggestions were proposed to promote the reform of the appropriate technology and advantageous disease types in TCM according to disease types in Guizhou Province.Results:Through interviews,we learned that most TCM clinical experts in non-pilot hospitals believe that the reform of payment by disease type for TCM dominant diseases is feasible to a certain extent,and they will give priority to TCM dominant diseases when treating diseases.After the reform,hospitals mainly have problems such as various forms of training but poor results,single form of supervision,weak performance management level,insufficient construction of relevant information systems and talent teams,poor quality of filling out the first page of TCM cases,and large differences in satisfaction with economic benefits among hospitals after the implementation of the reform.The field questionnaire survey revealed that only 31.0% of the clinicians in the pilot hospitals had participated in reform training three times or more;67.1% of the clinicians were accustomed to the relevant treatment changes brought about by the reform;after the implementation of the reform,61.0% of the clinicians indicated that the daily number of patients treated in their departments increased,58.8% indicated that the willingness to communicate with patients increased,43.8% indicated that the readmission rate of patients After the implementation of the reform,61.0% of the clinicians indicated that the number of patients treated in their departments per day increased,58.8% indicated that they were more willing to communicate with patients,43.8% indicated that the readmission rate of patients decreased,and 45.5% indicated that the average cost of hospitalization and the average length of stay of patients decreased;76.5% thought that the supervision of TCM cases was insufficient,and 25.2% thought that their own case filling behaviors were less standardized;the relationship between the change in performance after the implementation of the reform and whether the implementation of the reform had an impact on them was statistically significant by chi-square test P<0.001.In the pilot hospital,49.2% of medical staff in the medical insurance department and other related departments did not know much about the concept of TCM dominant disease categories,67.6% knew that the hospital was a pilot reform hospital,86.4% said that the hospital had organized training on reform,55.7% knew the main departments where the reform was implemented,and 41.4% knew only some of the TCM dominant disease categories.In non-pilot hospitals,83.9% of medical staff thought that the condition for reform implementation was a strict regulatory system,82.3% thought it was a perfect information system,42.7% thought the quality of the first page of TCM cases in their hospitals could meet the reform requirements,80.1% were most interested in knowing the standardized template of the first page of TCM cases,and 71.8% were most interested in knowing the rules of TCM disease coding.The differences were statistically significant(P<0.05)between the medical staff of the pilot and non-pilot hospitals in terms of their evaluations of the rationality of the currently selected superior disease types and the feasibility of implementing the reform in their hospitals in the future by chi-square test,and the evaluations of the medical staff of the pilot hospitals were higher than those of the medical staff of the non-pilot hospitals.Based on the field questionnaire data of the pilot hospital,the results of multi-factor logistic regression analysis showed that clinicians’ working years,their hospital level,the influence of combined Chinese and Western medicine treatment,whether they were accustomed to the relevant treatment changes brought about by the reform,and the supervision of Chinese medicine cases after the reform were the main influencing factors on clinicians’ behavior of filling out the first page of Chinese medicine cases(p<0.005);the The change of patient readmission rate after the reform implementation,the rationality of selection of dominant TCM diseases,whether medical costs were reduced,whether doctor-patient relationship was improved,and whether hierarchical diagnosis and treatment could be promoted were the main influencing factors for the feasibility of reform implementation from clinicians’ perspective(P<0.005);hospital level,rationality of current selection of dominant diseases,change of performance after the reform implementation,irregular medical record writing by doctors leading to entry errors,lack of attention by the hospital or medical staff did not pay enough attention,and most wanted to know the rules of TCM disease coding were the overall main influencing factors on the implementation of future reform(P<0.05).Conclusion:The implementation of the reform has saved medical insurance funds,reduced the average hospitalization cost and average hospitalization days,reduced the readmission rate and medical costs,increased the patient consultation rate,and promoted doctor-patient communication and graded treatment.However,since the reform is at the pilot stage,there are mainly problems such as weak publicity and training of policy knowledge,low understanding and participation rate of medical staff,weak construction of professional talents,unsound supervision and management system,imperfect construction of TCM coding and related information system,poor quality of filling out the first page of TCM cases,and large differences in cooperation with reform implementation in medical institutions at all levels;secondly,the reform implementation conditions in non-pilot hospitals are Secondly,the implementation conditions of the reform in non-pilot hospitals are weaker and need to be improved in terms of disease selection,information system,disease coding,cost measurement,etc.Therefore,in the future,the province should improve the relevant aspects when promoting the reform,the relevant departments of medical insurance should summarize and analyze the existing problems and optimize the reform implementation plan in time,medical institutions should continuously improve the reform implementation conditions and management system,medical staff should pay attention to the reform and actively learn the reform-related knowledge,etc.,so as to jointly promote the full implementation of the reform. |
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