摘要
目的评估某三级甲等综合医院科室及诊疗组的医疗服务运行现状,深入分析其在价值医疗维度下的表现,旨在为优化医疗服务、实现高价值医疗提供实证依据。方法以淮安市某三级甲等综合医院2023年1—6月和2024年1—6月所有住院患者病案数据为研究对象。研究从医疗服务能力、效率和安全3个维度进行多层次分析。特别对诊断相关分组(diagnosis-related groups,DRGs)病组中恶性增生性疾病的化学治疗和/或其他治疗患者进行专题研究,采用Kruskal-Wallis(K-W)检验比较不同诊疗组间住院日和费用构成(包括总费用、药费、治疗费及耗材费)的差异。结果在医院层面,病例组合指数(case mix index,CMI)达到1.17,较同期增长1.74%;时间消耗指数为0.92,较同期下降3.16%;低风险组死亡率降至0.10%,同比下降33.33%。在科室层面,分析发现部分科室的CMI相对较低,但其时间和费用消耗指数却高于区域平均水平。在诊疗组层面,同一科室内部不同诊疗组间的医疗服务能力和效率存在差异。进一步针对DRG病组中恶性增生性疾病的化学治疗或辅助治疗进行分析显示,在同一科室不同诊疗组间的比较中,患者的住院日、总费用、药费、治疗费和耗材费差异均有统计学意义(P<0.001)。结论本研究揭示了各科室及诊疗组间医疗服务能力和效率的显著异质性。为实现高价值医疗服务,医院需针对患者住院日和医疗费用进行精准化管理与持续优化,并制定精细化干预策略。
Objective To assess the operational status of departments and clinical service teams within a tertiary general hospital,deeply analyze their performance from the perspective of value-based healthcare,aiming to provide empirical evidence for optimizing healthcare services and achieving high-value healthcare.Methods This retrospective study analyzed medical records of all hospitalized patients at a tertiary general hospital in Huai'an City from January 1 to June 30,2023,and January 1 to June 30,2024.A multi-level analysis was conducted from three dimensions:healthcare service capability,efficiency,and safety.A specialized study focused on patients with malignant proliferative diseases requiring chemotherapy or adjuvant therapy within diagnosis-related groups(DRGs).Kruskal-Wallis tests were employed to compare differences in length of stay(LOS)and cost components(including total costs,medication costs,treatment costs,and consumable costs)among different clinical service teams.Results At the hospital level,the Case Mix Index(CMI)reached 1.17,increasing by 1.74%year-on-year;the time consumption index was 0.92,decreasing by 3.16%year-on-year;and the low-risk mortality rate dropped to 0.10%,a 33.33%yearon-year decrease.At the department level,analysis revealed that some departments had relatively lower CMI but their time and cost consumption indices were higher than the regional average.At the clinical service team level,differences in healthcare service capability and efficiency existed among different clinical service teams within the same department.Further analysis of malignant proliferative diseases requiring chemotherapy or adjuvant therapy in DRG groups showed that,in comparisons among different clinical service teams within the same department,statistically significant differences were observed in patients'length of stay,total costs,medication costs,treatment costs,and consumable costs(all P<0.001).Conclusion This study revealed significant heterogeneity in healthcare service capability and efficiency among departments and clinical service teams.To achieve high-value healthcare services,hospitals need to implement precise management and continuous optimization strategies for patient length of stay and medical expenses,and formulate refined intervention strategies.
作者
于芹
沈吉
刘娟
王志粉
邹瑜
YU Qin;SHEN Ji;LIU Juan;WANG Zhifen;ZOU Yu(Department of Operation Quality Management,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an Jiangsu 223300,China)
出处
《中国卫生标准管理》
2025年第13期84-89,共6页
China Health Standard Management
关键词
价值医疗
诊疗组
医疗服务能力
医疗服务效率
病种分析
精细化管理
value-based healthcare
clinical service teams
healthcare service capability
operational efficiency
diseasespecific analysis
precision management
