In the process of realizing the high-quality development of public hospitals, how to carry out multi-faceted and multi-dimensional management and control through DRG to improve the medical quality, medical safety and medical efficiency of hospitals?Based on the requirements of the national medical reform policy and the connotation of hospital management, combined with the practical experience of hospital management, this paper explains in detail the measures of DRG to help the high-quality development of public hospitals.
National medical reform policy requirements
(1) People's health needs
Socialism with Chinese characteristics has entered a new era, and the main contradiction in China's society has been transformed into a contradiction between the people's growing needs for a better life and unbalanced and inadequate development.
The report of the 19th National Congress of the Communist Party of China pointed out that people's health is an important symbol of national prosperity and national prosperity. It is necessary to improve the national health policy and provide the people with all-round and full-cycle health services.
The responsibility of the hospital should be changed from "focusing on disease" to "focusing on health", and the mission of the hospital is to take the people's demand for health as the goal of struggle.
(2) Deepen the requirements of medical reform
The goal of medical reform has changed from "basic medical and health services for all" to "providing all-round and full-cycle health services".
(3) National policy orientation
The main responsibilities of the National Healthcare Security Administration include continuously improving the level of medical security, ensuring the rational use, safety and controllability of medical insurance funds, and promoting the reform of the "three-medical linkage" of medical care, medical insurance and medicine, so as to better protect the people's medical needs and reduce the burden of medical expenses.
(4) National pilot requirements for payment by sick group
In 2019, the National Healthcare Security Administration held a meeting to launch the national pilot work of disease diagnosis-related subgroups (DRG) payment, and announced the list of 30 pilot cities in DRG payment countries.
The meeting required that all pilot areas should strengthen organizational leadership, implement relatively unified DRG group rules, payment policies and handling management norms, improve the medical insurance information system, and improve the management level of hospitals.
Hospital management connotation needs
(1) Realize the functional positioning of hospitals, and earnestly promote the implementation of the hierarchical diagnosis and treatment system
1.National Medical Center and National Regional Medical Center
The National Medical Center and the National Regional Medical Center are mainly responsible for the diagnosis and treatment of difficult, critical, and severe diseases, and lead the development of medicine in the region.
2.Hospitals
*The hospital provides diagnosis and treatment services for acute and critical diseases and difficult and complex diseases.
3.Level 2 hospitals
The secondary hospital receives patients in the recovery and stable phase referred by the ** hospital;Diagnosis and treatment of common and frequent diseases;Acute and critical care rescue and upward referral for difficult and complex diseases.
4.Primary medical institutions
Primary medical institutions provide first-class and nursing services for patients with chronic diseases, first-stage patients, geriatric patients, and patients with advanced tumors with clear diagnosis and stable conditions.
(2) Strengthen the management of public hospitals and establish and improve the modern hospital management system
In terms of governance mechanism, the first is to implement the first public hospital organization, supervision function and public hospital operation and management autonomy;The second is to establish a governance mechanism for decision-making, implementation, supervision, mutual coordination, mutual checks and balances, and mutual promotion.
In terms of operating mechanism, the first is to consolidate the achievements of the reform of canceling the addition of drugs and consumables;The second is to coordinate and promote the reform of medical care, personnel salary, drug circulation, and medical insurance payment;The third is to establish a new mechanism for the operation of public hospitals that maintains public welfare, mobilizes enthusiasm and ensures sustainability.
In terms of system construction, the first is to accelerate the construction of medical alliances and the contracted services of family doctorsThe second is to establish a medical service system with reasonable layout, division of labor and cooperation, and a hierarchical diagnosis and treatment pattern.
In terms of internal management, the first is to formulate hospital regulations and improve medical quality and safety management and performance appraisal systemsThe second is to promote the standardization, refinement and scientificization of hospital management.
(3) Completely abolish the use of medicine to maintain medicine, and improve and improve the drug security system
The first is to introduce a catalogue of generic drugs, which is updated and changed every year to better meet the needs of the masses and facilitate the diagnosis and treatment of doctors
The second is to formulate the "Measures for the Assessment and Management of the Rational Use of Drugs in Medical Institutions" to promote the high-quality development of pharmaceutical services and promote the rational use of drugs in clinical practice
The third is to increase the supervision of clinical drug use, fully implement the prescription review system, use information technology to implement dynamic monitoring and abnormal early warning of prescriptions, and timely intervene in irrational drug use
Fourth, the rational use of drugs is included in the assessment, which is linked to performance and title promotion
Fifth, the full implementation of payment according to the type of disease, the medical insurance payment method is completely reformed, through the reasonable coordination of the diagnosis and treatment management path of various diseases, clear fixed cost criteria, so that the use of medical insurance is more clear, efficient and standardized.
(4) Strive to give full play to their enthusiasm and fully reflect the labor value of medical personnel
Medical personnel are the main force in the reform of the medical and health system, and the key to medical reform and hospital development is to fully reflect the labor value of medical personnel and mobilize the enthusiasm of the vast number of medical personnel.
It is necessary to start from the aspects of improving remuneration, development space, practice environment, and social status, care for the physical and mental health of medical personnel, enhance the sense of professional honor of medical personnel through various forms, and create a good atmosphere of respecting medical personnel and valuing health in the whole society.
Medical and health institutions are allowed to break through the current level of wage regulation and control of public institutions;Medical service income is allowed to deduct the cost, and according to the provisions of the extraction of the main purpose of personnel rewards, at the same time to achieve the same post, the same salary and the same treatment, to stimulate the vitality of the majority of medical staff.
(5) Eight indicators
1.Number of DRG groups
The number of DRGs reflects the range of disease types covered by **cases.
2.Total weight
The total weights reflect the total output of hospitalizations.
3.Case Mix Index (CMI).
The Case Mix Index (CMI) reflects the level of technical difficulty of ** cases.
4.Discipline-based Balance (MDC).
Discipline Balance (MDC) reflects the lack of specialization and professional competence.
5.Time Consumption Index
The Time Consumption Index reflects the time consumed by the same disease.
6.Expense Consumption Index
The Cost Consumption Index reflects the cost of the same disease.
7.Low-risk mortality
Low-risk mortality reflects mortality in cases that are clinically at low risk of dying.
8.High-risk mortality
The high-risk mortality rate reflects the probability that a critically ill case will not be successfully resuscitated.
(6) Grouping principles and concepts
1.Grouping principle
The DRG grouping principles include the following:
1) Layer by layer refinement, general category;
2) The clinical process of disease diagnosis, surgery or operation is similar, and the resource consumption is similar;
3) Combination of clinical experience and data validation;
4) Take into account the management requirements of medical insurance payment and the actual needs of medical services.
2.Grouping concept
The DRG group adopts the idea of case-mix, and the different types of diseases should be distinguished by diagnosisSimilar cases but in different ways should also be distinguished by manipulation;The same kind of cases are the same way, but the individual characteristics of the cases are different, and they should also be distinguished by factors such as age, complications and comorbidities, birth weight, etc., and finally form the DRG group.
(7) The core role of DRG
The core role of DRG includes hierarchical diagnosis and treatment monitoring, key specialty review, grade hospital review, hospital quality and efficiency control, hospital performance appraisal, and national payment reform.
Hospital management practice sharing
(1) Free up space, adjust the structure, and implement the functional positioning of the hospital
1.Adjust the operational structure
The first is to be guided by social needs, inherit innovation, and expand the scope of medical services;
The second is to take the development of the hospital as the guide, continue to make efforts, and enhance the ability to diagnose and treat acute and critical cases
The third is to take discipline construction as the guide, revive surgery, and strengthen the depth of discipline development
The fourth is to take discipline construction as the guide, highlight the brand, and enhance the influence of medical services
Fifth, we should take discipline construction as the guide, innovate technology, and enhance the core competitiveness of hospitals.
2.Adjust the structure of the disease
The first is to adjust the surgical structure of diseases and improve the ability to diagnose and treat diseasesThe second is to emphasize the difficulty coefficient of diagnosis and treatment and improve the level of discipline servicesThe third is to optimize the specialty characteristic diseases and effectively promote the development of disciplines.
(2) Strengthen quality, lay a solid foundation, and promote the improvement of hospital quality and efficiency
1.The hospital is united with the department
At the decision-making level, a medical quality and safety management committee was establishedAt the executive level, a medical quality management organization at the hospital and department levels was established, in which the department director is the first person responsible for the medical quality management of the department, the deputy director of the department is the main person in charge of medical quality management, the leader of the medical team is the person in charge of the medical quality management of the group, and the quality control personnel of the department are the implementers of the implementation of medical quality.
At the hospital level, carry out pre-job training, full staff training, special training, written examination and assessment for new employeesAt the department level, we carry out quality control training, medical record homepage filling training, etc.
2.Quality control and data federation
The first is to obtain relevant data such as the proportion of drugs, the proportion of consumption, and the average length of stay in each department, compare the benchmark values, reasonably formulate target values based on the discipline level and development characteristics, and adjust them in a timely manner according to the actual situation.
The second is to regularly publicize the medical-related data of each discipline, analyze various data in a timely manner, and realize the control of the average length of hospital stay before surgery, the tracking of low-risk death cases, and the tracking of abnormal data on the incidence of postoperative sepsis.
(3) Establish a system and set standards to improve the satisfaction of doctors and patients
1.Implement precise punishments
Strengthen the control of irrational use of medicinal materials, unreasonable medical treatment, and excessive inspection and inspection.
The first is to increase the training of rational drug use;The second is to strictly control the irrational use of antimicrobial drugs, including the formulation of the "Management System for the Authorization and Reauthorization of Antimicrobial Drug Prescription Rights", the issuance of the "Notice on Further Standardizing the Clinical Application of Antimicrobial Drugs", the preventive application of perioperative antimicrobial drugs, and the application of antimicrobial drugsThe third is to strictly control the irrational use of auxiliary drugs, including procurement and use.
2.Seek precise incentives
Hospitals should pay attention to the following points to improve the performance evaluation indicators of medical staff (using DRG):
The first is to highlight the performance of job responsibilities, workload, service quality, code of conduct, medical quality and safety, medical cost control, medical ethics and patient satisfaction and other indicators
The second is to implement classified assessment for medical personnel in different positions and at different levels;
Third, the assessment results are linked to the employment of medical staff, the promotion of professional titles, and personal salaries.
Original title: How does DRG help the high-quality development of public hospitals?
* |Golden Beans Data.
Edit |Zhang Chenxuan, Wu Hanxiao.
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