摘要
紧跟国家政策导向,在DRG付费管理背景下,为军队医院更好地适应DRG支付模式,笔者积极探索与地方医保改革政策相适应的措施,通过建立医院DRG领导小组,强化医院信息系统建设,成立院内DRG质控专家组,常态开展DRG知识培训考核,嵌入病案首页质控机制,引入DRG智能小助手,优化临床诊疗过程,建立数据质量监控和沟通反馈机制,加强运营数据监管及考核等措施,并回顾性收集2022年4—9月某二级甲等军队医院DRG支付试运行期间结算情况变化。医院掌握DRG入组规则及付费结算方式,结算患者入组率逐渐提升,由97.72%上升至100.00%,CMI值呈波动式上升,高于本市同级别医疗机构平均值,平均住院日由10.14d波动式下降最低8.31d。医院医疗质量监管方向更明确,管理更加智能化,学科发展方向更加清晰,更加注重内部成本控制,更加注重内涵式发展,更加注重体现医疗服务价值,为后期军队保障患者全面实施DRG付费打下坚实基础。
Under the background of DRG payment management,in order for military hospitals to better adapt to the DRG payment model,the authors have actively explored the measures that are compatible with the local medical insurance reform policies,namely,establishing a hospital DRG leadership group,strengthening hospital information system construction,establishing an in-house DRG quality control expert group,regularly conducting DRG knowledge training and assessment,embedding a medical record homepage quality control mechanism,introducing DRG intelligent assistants,optimizing clinical diagnosis and treatment processes,establishing data quality monitoring and communication feedback mechanisms,strengthening operational data supervision and assessment,and retrospectively collecting changes in the settlement situation during the DRG payment trial operation period of a 2a military hospital from April to September 2022.The hospital has mastered the DRG enrollment rules and payment settlement methods.The enrollment rate of the settled patients has gradually increased from 97.72%to 100.00%.The CMI value has fluctuated and risen,which is higher than the average of the medical institutions of the same level in the city.The average length of hospital stay has fluctuated and decreased from 10.14 days to a minimum of 8.31 days.The direction of medical quality supervision in hospitals is more explicit.The management is more intelligent.The development direction of disciplines is clearer.More emphasis is placed on internal cost control.More emphasis is placed on connotative development,and more emphasis is placed on reflecting the value of medical services.A solid foundation is laid for the military to ensure the patients in the full implementation of DRG payment in the future.
作者
张露萍
梁永建
ZHANG Lu-ping;LIANG Yong-jian(No.945 Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army,Ya'an 625000,China;Central Health Center of Bifengxia Town,Ya'an City,Ya'an 625000,China)
出处
《现代医院管理》
2025年第6期89-92,共4页
Modern Hospital Management
关键词
DRG付费
军队医院
实践
DRG payment
military hospital
practice
