The Impact Of DRGs On Medical Quality

Objective: With the increasingly prominent problem of medical insurance payment,controlling the growth of medical expenses has become an important global problem.In order to control the growth of medical expenses and effectively solve the problem of difficult and expensive medical treatment,China adopts diagnosis related groups(DRGs)to control the growth of medical expenses.In the pilot process,it is found that although the health expenses have been controlled to a certain extent,it may be accompanied by the decline of medical quality.Therefore,according to the characteristics of significant changes in medical quality in the pilot area and the response of DRGs payment system,this study selects a public hospital in the DRGs pilot area as a sample hospital for empirical research,The purpose is to explore whether the medical quality of public hospitals will change to a certain extent under the implementation of DRGs,analyze the changes and influencing factors of medical quality under the DRGs payment system,and discuss the DRGs system optimization strategy and medical quality improvement strategy.Methods: empirical research was used to analyze the implementation of DRGs payment system in the selected sample hospitals,and the key quality indicators and medical insurance DRGs data before and after the implementation of DRGs in the sample hospitals were selected for statistical analysis.According to the influence of DRGs before and after settlement on the average hospitalization expenses and average hospitalization days of patients,a comparative analysis was carried out.Other service capacity,service efficiency and comprehensive capacity are also analyzed through the key indicators of DRGs,and compared with the traditional project-based payment system.Finally,the purposive sampling method is used to select the main stakeholders implementing the DRG payment system in Shenzhen,including medical insurance institutions Medical institutions and medical personnel analyze the positive effects and unexpected results of the DRG payment system in the pilot area on the main stakeholders,analyze the internal mechanism of the implementation effect of the DRG payment system in the pilot area from the interest demands of the main stakeholders of the DRG payment system,and put forward targeted policy suggestions and measures to solve various unexpected effects.Results: 1.The empirical research results of sample hospitals show that the average hospitalization cost per time increases significantly.The average hospitalization cost per time increases by about 8.6%(P < 0.001)one year after the implementation of DRGs compared with the previous implementation,but the growth rate decreases.2.There was no significant change in the average length of hospital stay one year after the implementation of DRGs payment system(P > 0.1),but it was significantly shortened two years after the implementation(P < 0.001).3.Before the implementation of DRGs,compared with the two years after the implementation,the number of enrolled groups increased continuously(698 vs726),while the enrollment rate also increased(97.67% vs 98.87%),and the CMI value of service level increased significantly(0.98 vs 1.16).4.Compared with before the implementation of DRGs,the time consumption index and cost consumption index increased two years after the implementation of DRGs,including EC(0.94 vs 1.12),et(0.98 vs 1.16),the efficiency of medical services decreased,but the number of MDCs increased(23 vs 24).5.Among the related indicators of in-hospital mortality,the mortality of low-risk group increased two years after the implementation of DRGs,but there was no significant difference(P > 0.5),the mortality of rescue cases decreased significantly,from 13.94% to10.7%(P < 0.001),and the mortality of non rescue cases did not decrease significantly(P > 0.05).6.Among the return related indicators,the unplanned readmission rate did not increase significantly(P > 0.05),and the unplanned operation rate increased significantly after the implementation of DRGs(P < 0.05).7.Among the indicators related to adverse events,the nosocomial infection rate increased from 1.569% before the implementation of DRGs to 2.837% two years after the implementation(P < 0.001).Among the indicators of postoperative complications,the infection rates of pneumonia and blood increased,and the infection rates of urinary system,pressure ulcer and artificial airway prolapse decreased.8.The clinical pathway decreased significantly(P < 0.001).Conclusion: 1.According to the results of empirical research,the DRGs payment system implemented by the sample hospitals effectively controlled the excessive growth of patients’ hospitalization expenses and reduced the burden of patients’ personal hospitalization expenses.2.DRGs can shorten the average length of hospital stay to some extent,but it will lead to readmission or early discharge of patients with long hospital stay.3.After the implementation of DRGs,the scope of medical services has been expanded,the CMI value has been improved,and the level of medical technology has been improved.4.On the premise of ensuring patients’ medical quality and medical safety,sample hospitals urgently need to improve medical and health efficiency,including time consumption index and cost consumption index.5.The mortality of rescue cases has been significantly reduced,and the rescue ability of the hospital has been improved to a certain extent,but the mortality of non rescue cases still needs to be reduced.6.The unplanned operation rate of surgical patients is high,so it is necessary to strengthen the operation safety,make postoperative follow-up records and strengthen intelligent monitoring.7.After the implementation of DRGs,the nosocomial infection rate increased significantly,so it is necessary to strengthen the control of nosocomial infection.8.Hospitals need to increase the proportion of clinical pathways,pay attention to refining regulatory rules,improve clinical pathways and single disease payment management system,and build a DRGs medical and health service system centered on patient health.