article comes from hospital performance consulting new knowledge. Authors, including Chunchun, Zhou Dian, et al.
Abstract
Purpose: By conducting a comprehensive evaluation of medical service output, doctor's technical level, medical resource consumption degree and medical quality, we analyze the differences in medical service situations in the sample hospitals, and provide a reference for improving medical service performance and medical level.
Method: Taking general surgery with many patients, complex diseases and high medical difficulties as an example, we collected relevant data on hospitalized patients in each ward in 2020, and used the disease diagnosis-related grouping (DRG) indicators combined with the comprehensive index method to evaluate the performance of six wards of general surgery from the dimensions of service ability, efficiency, and safety.
Results: There are differences in the medical service levels in the six wards of general surgery, and their advantages and disadvantages are found in the dimensions of medical service capabilities and efficiency.
Conclusion: DRG combined with the comprehensive index method can be effectively applied to the performance evaluation of medical services in hospitalized patients, providing suggestions and strategies for promoting the ward to improve medical service capabilities, improve medical service efficiency, optimize safety and quality assessment indicators, and achieve overall balanced development.
The "Notice of the National Health Insurance Administration, Ministry of Finance, National Health Commission, National Health Commission, National Administration of Traditional Chinese Medicine on Issuing the List of National Pilot Cities for Paying for Groups Related Groups by Disease Diagnosis" (Medical Insurance Fa [2019] No. 34) issued in May 2019 proposed that in order to deepen the reform of medical insurance payment methods and accelerate the promotion of national pilot work for grouping for Groups by Disease Diagnosis (DRG) payment, 30 cities, including Hefei, were identified as national pilot cities for paying for DRG. Enable payment by DRG and evaluating medical services based on relevant indicators can significantly improve medical service performance, improve medical level, effectively improve the efficiency of medical supplies, reduce medical expenses, and shorten hospitalization days. General surgery is a key department of the hospital. Due to the large number of patients stored, the complex and diverse types of diseases, and the severity of the disease, it is often divided into multiple wards, with specialized and subspecialized characteristics. Traditional inpatient medical services are mostly evaluated through questionnaires and other methods. The survey speed is slow and the scope of research is limited, making it difficult to accurately reflect the severity of the disease admitted in each ward of general surgery and its difficulty in treatment. At this stage, during the domestic pilot exploration period for the DRG payment work, fewer evaluations are used in general surgery inpatient medical services. Therefore, this study takes the general surgery department of a large tertiary grade A comprehensive hospital as an example. First, use the DRG indicator to evaluate the medical service level in different wards from three dimensions, and then conducts a comprehensive evaluation and analysis of the overall medical performance. Based on the research results, relevant suggestions for hospital performance appraisal and refined management of are put forward, providing a basis for promoting the reform of the medical insurance payment system.
Data and methods
.1 Source
High-level A comprehensive hospital was selected as the research object in this study. The hospital has good medical and health resources and first-class medical services. It is one of the earliest hospitals in Anhui Province to carry out DRG pilot. The research data comes from the homepage of the medical records of patients discharged from 6 wards in the hospital from January to December 2020. Extreme values such as hospitalization days exceeding 60 days and hospitalization costs below 5 yuan, and cases of transfer, death, and withdrawal of paid DRG, and finally 11,053 qualified cases were included.
.2 Evaluation indicator
.2.1 Medical service capability indicator
Medical service capability is usually evaluated using the DRG group number, total weight, and case combination index (CMI). DRG group number represents the range of diseases covered by the patients admitted to the ward. The more groups the number, the wider the disease diagnosis and treatment services provided by the ward. Weights are the output of hospitalization services based on DRG risk-adjusted to disease types. The greater the weight, the more services it provides. CMI = total weight of discharged cases/total number of cases, which is the average weight of cases and is related to the type of disease admitted, and is used to reflect the technical difficulty and medical technology level of the disease.
.2.2 Medical service efficiency indicators
Medical service efficiency indicators are generally commonly used for time consumption index and cost consumption index. The time consumption index and cost consumption index are obtained by standardizing the hospitalization days and hospitalization expenses, and can reflect the time and expenses required to treat the same type of cases in different wards.
.2.3 Medical safety indicators
Mortality rate in the low-risk group is often used to evaluate medical safety. These indicators can reflect the scientific nature and effectiveness of DRG in disease risk adjustment and performance evaluation. Compared with traditional performance evaluation, the differences and difficulties in disease types and treatment methods are increased.
.3 Research method
The comprehensive index method is to process a group of the same or different indexes using statistical methods and convert them into a comprehensive index. first standardizes the indicators based on the average value of each indicator, and calculates the total comprehensive index based on the principle of "multiplication of the same dimensions and addition of different dimensions". This method is used for comprehensive evaluation to improve the comparability among various DRG indicators and evaluate the overall performance of medical services. In this study, since the low-risk mortality rates are all 0, the safety comprehensive index is assigned a value of 1.
2 Results and analysis
2.1 Analysis of medical service capabilities
From the perspective of overall medical service capabilities:
The third ward has the highest comprehensive score and the strongest service ability;
The fifth ward has the second comprehensive score and ranks second in ability;
The second and sixth wards are poor, with scores significantly lower than the average. Half of the wards in
have 100 DRG groups;
has the lowest number of DRG groups in the second ward, with only 25 groups.
In addition, the CMI and scores of the third, fifth and sixth wards are all 1 point, and the CMI and scores of other wards are all 1 point.
The total weight score is 1 and half of the wards are 1 (Table 1).
Overall, the differences between the six wards at the CMI level are small, but there are large differences in the number of DRG groups, total weights and comprehensive scores. All indicators in the second ward are worse than other wards.
2.2 Medical service efficiency analysis
For different wards of the same department in the same hospital, the cost of treating the same type of disease and the length of hospitalization are used to indicate the medical service efficiency of each ward. When the time consumption index and cost consumption index = 1 or close to 1, it means that the resources consumed by the ward to treat the same type of cases are close to the average level. The lower the value, the shorter the time or the less cost to treat the same type of cases.
From the perspective of overall medical service efficiency, the first, third and fourth wards are better, scoring 1 point each, while the second, fifth and sixth wards score 1 point and have poor efficiency. The time consumption index of the six wards of the general surgery department is all 1. The cost consumption index of the third and fourth wards is lower than 1, while the cost consumption index of other wards is 1 (Table 2). In addition, the third and fourth wards performed more prominently than other wards in terms of time consumption index, cost consumption index and comprehensive efficiency index, while the second ward performed relatively poorly in all three dimensions.
2.3 Medical Service Safety Analysis
The low-risk mortality rate represents the risk of death in cases with milder conditions. It is the proportion of deaths in the low-risk group to the total number of people in the low-risk group. Low risk means that the possibility of death from the disease itself is extremely low. Most of the deaths in the low-risk group may be due to errors in the medical process. Low-risk mortality indicators can more sensitively reflect medical quality and safety. As can be seen from Table 3, in terms of medical service quality and safety, the low-risk mortality rates of the six wards of the General Surgery Department are all 0, the comprehensive safety index is 1, and the safety level is basically the same.
2.4 Evaluation of overall medical services in each ward
Considering the overall medical service level of general surgery from the comprehensive index of three dimensions: service capability, service efficiency and quality and safety, it was found that the comprehensive index of the third, fourth and fifth wards ranked in the top three.Among them, the comprehensive capacity index and comprehensive efficiency index of wards 3 and 4 are both 1. The comprehensive capacity index of the five wards ranks second, but the comprehensive efficiency index is far behind. 2. The comprehensive capacity index and efficiency index of the six wards are both 1, and the overall medical service capacity is lower (Table 4). Overall, there are differences in the comprehensive capacity index and efficiency index of each ward of general surgery, and the comprehensive safety index is relatively consistent.
3 Discussion and suggestions
Traditional clinical ward hospitalization medical service evaluation is mainly based on indicators such as the number of discharge cases, average cost, and average hospitalization day of . It cannot reflect the service level and technical difficulty of each ward during the disease diagnosis and treatment process, and it is difficult to make horizontal comparisons of the service capabilities, service efficiency, quality and safety of the wards. uses DRG-related indicators to evaluate the performance of each ward of general surgery. It can comprehensively consider the difficulty of the disease, the technical level of the doctor and the consumption of medical resources. It is currently a relatively common medical institution performance evaluation method for in the medical field. The standardization of hospitalized cases by can more realistically and objectively evaluate the differences in diagnosis and treatment levels between doctors and wards. Performance evaluation was conducted through the DRG index and comprehensive index method, and it was found that there were significant differences in the medical service capabilities and efficiency indicators of the hospital's general surgery wards, and the overall level needed to be improved.
3.1 Some wards have insufficient medical service capabilities, and the overall level needs to be improved
Some wards of the general surgery department of the hospital can provide a wide range of disease diagnosis and treatment, while other wards need to improve the disease diagnosis and treatment scope and expand service capabilities. Especially in Ward II, the ability to treat diseases is limited and needs to be improved. The technical difficulty of treating cases in wards 3, 5 and 6 is higher than the average level of general surgery, which is closely related to the relatively largest output of inpatient medical services in the ward. The technical difficulty of treating cases in other wards is lower than the average level of general surgery. In addition, the total output of hospitalization services in half of the wards needs to be increased. Ward 2 has the weakest overall medical service capacity and needs to be taken seriously. Hospitals should set performance appraisal goals to encourage wards with weak service capabilities to expand their service scope and increase the number of DRG groups, so as to encourage wards with low technical difficulty to treat patients to increase the difficulty of treating diseases. At the same time, rectification requirements are put forward for wards with low total service output to increase the total output of departments. Starting from three aspects: DRG group number, total weight, and CMI, the development direction of each ward is formulated to improve the overall medical service capabilities of general surgery. If the service capabilities of the three wards rank high, their total weight and CMI are higher, but their DRG groups are smaller, and their service capabilities are affected to a certain extent. Therefore, while increasing the difficulty and technical difficulty of treating diseases, we also need to consider the breadth of medical services and improve our comprehensive strength.
3.2 The treatment costs in a few wards are high, and the efficiency of medical services needs to be improved. The average hospitalization time of 16 wards is lower than the average level of general surgery, indicating that the hospitalization time of patients in each ward of general surgery is well controlled and should continue to be maintained. The second ward has the largest time consumption index and the lowest score, which means that the hospital stay is relatively long and the turnover is slow, which is lower than the level of other wards, which can be further improved. Only a few wards spend less than the average medical expenses for treating patients, and most wards spend more than the average medical expenses for treating patients, which is closely related to the types of diseases admitted to the ward, the clinical manifestations of the disease, the implementation of clinical pathway , etc. It is necessary to further control the consumption of costs during the medical process. If we want to improve the efficiency of medical services in the corresponding ward, we need to target the medical expenses in accordance with the types of diseases admitted to the ward. Hospitals can control the positioning of the ward, optimize the disease type structure, set corresponding reward and punishment measures, standardize the medical behavior of doctors, reduce the cost index of the relevant wards and reasonably control the time index, and thus improve the overall medical service efficiency of the department. For example, the number of DRG groups admitted in the second ward is relatively small, the total weight and CMI are relatively low, but the treatment costs are relatively high. This shows that the disease type structure and the doctor's diagnosis and treatment behavior need to be improved and standardized. The number of patients with milder conditions should be reduced accordingly, the number of patients with more difficult diseases should be increased, the structure of diseases should be optimized, and the medical behavior should be standardized.
3.3 The medical service safety situation in each ward is good, and the assessment indicators still need to be optimized
The low-risk mortality rate and comprehensive safety index of the six wards of general surgery are the same, which shows that to a certain extent that the safety level of each ward is basically the same and the safety efficiency is good. This also indirectly reflects that the low-risk mortality alone cannot fully reflect the level and differences in quality and safety of each ward within the department. For performance assessment of safety efficiency, hospitals and relevant departments need to make more detailed considerations and refinements, and formulate more complete performance assessment mechanisms and indicators.
3.4 There are differences in overall medical services in each ward, and comprehensive and balanced development
General Surgery wards have differences in medical service capabilities, service efficiency, comprehensive index, etc. Since the comprehensive safety index of each ward is the same, the comprehensive capacity index and comprehensive efficiency index of the three wards are ranked first, so it ranks first in comprehensive. Similarly, Ward 2 ranked 6th in comprehensively. The five wards ranks second in the comprehensive ability index, and the efficiency comprehensive index ranks low, and the comprehensive ranking is third. It can be seen that the overall medical service level of each ward depends on three dimensions: medical service capacity, efficiency and safety. To improve the overall medical service level, each ward needs to take into account three aspects at the same time, clarify its own advantages and gaps with other wards, and clarify the direction of improvement. Hospitals should comprehensively and objectively evaluate the medical performance level of the ward and guide the ward to develop with high quality, efficient and balanced development.
4 Summary
With the promotion of DRG technology, the use of DRG indicators for medical service performance evaluation can compare the medical service level from multiple angles, find differences between different hospitals, departments and wards, and make rectifications for weak links to improve the overall medical level of the hospital, which is conducive to the hospital's refined management. However, in this study, the safety index of each ward is 1, and the medical quality is generally good, so it is difficult to compare it further. It can be seen that with the overall improvement of medical level, some indicators may not be able to reflect the specific differences in medical level and have certain limitations. Hospitals should flexibly use DRG indicators, combine them with traditional medical performance appraisal and their own reality, and implement more scientific and refined hospital management.
original text: Medical service performance evaluation of hospitalized patients based on DRG and comprehensive index method, please contact Chunchun, Zhou Dian, Tiandi, Zhou Yuan, Wang Heng, Yang Yan, Liu Yaoyao, Wang Haoyu, Wu Feng, China Hospital Management, 2022; only learn communication and use, if there is any infringement, please contact us to delete it.
