The Study On The Impact Of The Clinical Path And DRGs To County Hospital Reform

From the end of2009,in order to implement the spirit of the "The opinion and advice towards the further reform of the medicine and hygiene system by the The state council under the central committee of the communist party of China "and "The opinion and advice on pilot reform of Public hospital",stick to the public welfare with the basic medical care of the public hospital,promote the innovation in systems and mechanisms,The world bank loan center/DFLD China’s rural health development projects (Hereinafter referred to as the11th Healthy Project)carry out the rural medical institutions in clinical diagnosis and treatment technology optimization and compensation mechanism reform pilot work (Hereinafter referred to as Pilot Projects),in order to find the best comprehensive health care reform mode of public hospitals at the county level.Main objective:Through collecting the related data of the1lth Healthy Project about the2pilot hospitals and4compared hospitals in rural medical institutions clinical diagnosis and treatment technology optimization and compensation mechanism reform work, summarized the beneficial experience and lessons, and give the comprehensive evaluation on the effect of intervention.Methods:Choose the2pilot hospitals, according to the economic and social development of the pilot county hospitals and the principle that everything is close to the pilot county hospitals,select4compared hospitals. In the1st Hospital of Habin Area extract six diseases as Natural labor vaginal delivery、Inguinal hernia、Emergency cesarean section and planned cesarean section、cerebral hemorrhage、cerebral infarction and Gall bladder benign lesions. In the Central Hospital of Qianjiang Area extract six diseases as Natural labor vaginal delivery、planned cesarean section、adults Inguinal hernia、Simple appendicitis、Gall bladder benign lesions and Cerebral infarction. And then assessment all the diseases above. In allusion to the2pilot hospitals and4compared hospitals, respectively extracting the Hospital medical records of the7diseases from January1,2010to July10,2011. Every hospital each month to select10patients from each disease. If some diseases into the clinical path management pilot hospital patients less than10cases, it will be polished with same disease to treatment of patients who were not included in the path of the completion.In addition, the project also adopted key figures interviews, in the process of the interview record notes and recording. Interviews include:scope of the implementation of clinical pathway and effect, the medical service price of single diseases or health insurance pricing changes, the reform of hospital distribution system of form a complete set, etc.Quantitative analysis and qualitative analysis methods are combined. The quantitative data analysis use descriptive statistical analysis, single factor analysis. In addition, in order to balance the differences between the two comparison groups, the propensity score matching method is adopted to balance the differences between the two comparison groups, and using the double difference method to calculate press disease to pay compensation mechanism reform of county-level hospitals optimization path specification for clinical diagnosis and treatment technology. Analysis of the qualitative interview data through all the notes and recording for on site.The main results:Patients into the clinical pathway with cerebral hemorrhage cure and recovery index rise up to50.87%; Compared to the hospitals before the pilot program, the hospitals after the pilot program increase more than50%; Followed by the patients with cerebral infarction. Natural labor, cesarean section, inguinal hernia, cure, the simple appendicitis patients did not change.The hospitalization cost of patients into the clinical pathway of gallstones in inguinal hernia has a downward trend, and cesarean delivery, simple appendicitis, cerebral infarction, cerebral hemorrhage hospitalization costs are on the rise.Project into hospital clinical pathway of diseases out-of-pocket costs accounted for most of the hospitalization cost is on the decline.Project into hospital clinical pathway of simple appendicitis, gallbladder stones, in guinal hernia, cesarean section patients’ hospitalization days is on the decline, bleeding in the brain is on the rise.Two projects into hospital antimicrobial drug use days change trend of clinical pathway in patients with inconsistencies, showed a trend of shortening the marina area, including han and qianjiang showed a trend of extending.Hospital information system construction and form a complete set of distribution system reform gradually, the reform of hospital medical staff enthusiasm for the work of pilot are increasing.Conclusion:1) Overall medical service quality increased;Individual disease of individual index fell, related to the clinical path design.2) Cost burden for patients had a certain degree decline, and tend is reasonable; Hospital efficiency improved.3) Cost control effect has been preliminary revealed, pilot disease to pack to pay prices make balance basically all have certain levels of medical institutions.4) It’s necessary to carry out the reform of internal distribution system of medical institutions.5)"3+1" county-level hospitals comprehensive reform model is worth affirmation.Policy recommendations:1) Strengthen the coordination of all departments. 2) Strengthen the provincial experts team form and training work to meet the project demand of rapid development.3) Strengthen the clinical pathway of propaganda work to the public, improve the residents awareness of the clinical pathway.4) To protects the reasonable interests of the hospitals and the medical staff is the precondition for the implementation of pilot hospital clinical pathway work.5) Select qualified, high levels of company development unified HIS and clinical pathway for around software, and strengthen information management.6) Continue the cooperation method in the project.7) Expand DRGs and clinical path.