The Feasibility Study Of Improving DRGs With Essential Healthcare Technology Package

BACKGROUNDThe World Health Report 2000 developed an index system to evaluate national health systems' performance in order to achieve three overall goals, while the most important one is good health. Progress towards it depends crucially on how well systmes carry out health services. It is the urgent task for health care facilitites and research institution to improve the performance of health service delivery in the context of insufficient health resource. The strategy commonly allowed is to develop a new-style healthcare management mode, Diagnosis related groups system (DRGs) could be an answer because of it's advantage.There are some factors influencing the preformance, such as the flow of health service delivery, the allocation of healthcare technology. Essential Healthcare Techology Package (EHTP) is a comprehansive tool for rational planning and management of health care technology interventions, based on identification and quantification of all resources (including human resource, medical device, facility, and drug), which are needed in healthcare prodedures for the majority of diseases and health -related conditions.In this research, EHTP is tentatively applied into DRGs. And the/expected outcome is a new-style healthcare management mode which can be carried out in the healthcare institution.OBJECTIVEBased on the clinical pathway, EHTP is applied into DRGs to identify and quantify all resources which are necessary during the process of healthcare service delivery, and to confirm the right mix of healthcare technologies for all medically recognised healthcare interventions by optimal intervention, which may improve the performance of healthcare delivery. At the same time, the feasibility of EHTP used in the hospital mangement will be assessed.METHODOLOGYThe cross-sectional study is used in the baseline research, and the main part is clinical intervention test.Data Collection Method: literature review, medical record review, key informant interviews, field survey, structural observation, situation analysis, typical survey, and so on.Data Analysis Method: single index comparison method, multi-index comparison method (Technique for order preference by similarity to ideal solution, TOPSIS), time series comparison method, cost analysis, and so on.The tool used to draw and analyise the Clinical Pathway is EHTP.CONTENT AND RESULT· Situation analysis and typical survey in Zhejiang ProvinceSituation analysis was carried out in Zhejiang Province, and its aim was to understand the factors influencing the healthcare outcome. The content included demograhic and socioeconomic factors, healthcare needs and access to other basic need, health resource allocation, and so on. This phase research was composed of province and city levels. According to the sodoeconomy level, there were four cities selected as the representative of the local condition, including Hangzhou city, Jinhua city, Huzhou city and Shaoxing city. Cross-sectional study was adopted in this process. Based on the WHO'S Guideline, the questionnaire was developed. Before the investigators filled in the questionnaire, they were trained in a formal workshop. The data were dealed with by time series and comparison analysis to demonstrate the difference between the province and country level.Typical survey was involved in 9 hospitals of different level from 4 sample cities. The content of survey included not only the hospital overview, resource allocation, healthcare delivery performance, and economic status, but also the medical device audit, since the medial device was the one of the most important factors influencing the healthcare service delivery.The result showed, the healthcare resource was insufficient, whilehealthcare service can't meet the need of population, so the healthcare institution was trying to develop an appropriate management mode to improve the performance of healthcare service.· Pilot study of EHTP in the sample hospitalAccording to the hospital's size, its compliance to this research, Shaoxing University Affiliated Teaching Hospital (SUATH) became the sample site to carry out the pilot study. This phase research was involved in Orthopedics Department, referred to 4 common diseases, that were fracture of long bone of four limbs, lumbar intervertebral disc protrusion, open injury of fingers, fracture of lumber vertebra.With the theoretical framework of this research, this pilot study included 4 parts:1) Modifying EHTP template.The EHTP package consists of two main components, one is generic template and the other is simulation tool. In generic template, there are four basic databases( that are human resource database, medical device database, facility database and drug database). Before using it, it is necessary to modify the template, which means to enter the local data into as the baseline for analysis. So according to the form of EHTP, the data about the human resource, medical device, facility and drug were collected and entered into software to develop a local-specific template which more accurately reflect local conditions and realities.2) Developing the local clinical pathway(LCP) and optimal clinical pathway(OCP), and making the Gap-analysis by EHTP.Firstly, through the key informant interviews and medical record review, the information about the flow charts of 4 selected diseases were attained to explain how the local doctors deal with the patients, and based on that, the local clinical pathways were drafted, which were made up of several procedures. The various technologies and the time of each procedure were confirmed by strutural observation.Then, the optimal clinical pathways were developed according to the experts opinions and clinical evidence to solve the problem that existed in thelocal healthcare service. The aim was to develop a more reasonable, effective and economical flow chart.With the simulation tool in EHTP software, the various technologies were identified and quantified seperately based on the LCP and OCP. Then the result were made a gap analysis with each other and with the local allocation condition.The result showed, the quantity of technologies which need in LCP was more than the allocation amount, but the quantity of technologies needed in OCP was less then that in LCP, that was to say, technologies in OCP were more suitful sample hospital than those in LCP.3) Definiting the intervention model, and estimating the cost of each disease.Based on the result of EHTP, the intervention model was definited to optimize the flow chart of healthcare service and to improve the effectiveness of medical device utility.Cost analysis of each disease was done to make sure the economy effect of this model, the result showed, the cost would be down by implementing this model.4) Implementing intervention model and evaluating it.The intervention time was from 2004 September to 2005 February, totally 6 months. Before it carried out, a formal workshop was hold to introduce the model to all the related persons, including doctors, nurses, and so on. During implementation, two persons of research team were charged of reviewing the medical record of 4 diseases to controll the implementing quality, and discussed with doctors about the problems that they met to solve them.For the principle of homogeneity comparison, all patients of 4 selected diseases from 2003 September to 2004 February were selected as the controll group, and the patients during the implementation as the intervention group. The comparison indexes included length of stay, number of test, prognosis,total cost, total fee, patient satisfaction, and so on. At the same time, TOPSIS was applied to synthetically compare the differece between two groups. The result showed, the performance of the intervention group was better than the controll group, that was to say, intervention model achieved...