The Research On Medical Quality Evaluation Of Single Disease Quota Payment Based On A Third-Level 1sth Class Hospital In Hainan Province

ObjectiveThe use of reasonable and effective medical quality evaluation, explore disease before and after the implementation of the single DRGs way, affect the quality of medical care arising from right, in order to improve medical expenses payment reforms our country, improving the quality of medical services, put forward a sound single disease payment basic conditions of reform, considering the promotion of the relationship between medical costs and medical quality control, and promote policy recommendations for sustainable development of clinical pathways and the like.MethodsSelect a top three hospital, Hainan Province as the research object. First, according to the actual situation of the implementation of the single object of study DRGs reform, combined with expert advice, choose a cesarean universal, representative, senile cataracts, acute simple appendicitis and uterine fibroids four single disease, as samples; secondly, by referring to "structure process-result" mode and currently more authoritative organization of medical quality evaluation index, combined with the actual situation of research object, and on the basis of expert advice on selecting a reasonable and effective quality of care evaluation, including:routine preoperative examination, other check preoperative diagnosis rate, postoperative use of antibiotics for several days, the number of days of hospitalization, the patient information is available rate, postoperative infection rates, improve the cure rate, total health care costs; Furthermore, based on the sample of disease and medical quality evaluation determined, field data collection; and finally, the use of quantitative and qualitative analysis of a combination of relevant data and information collected and analyzed research results As a result, and the results were discussed in depth study. Quantitative data were analyzed using descriptive statistics, independent sample T-test analysis, under the premise of a statistically significant, then the use of fold differential analysis of medical quality evaluation, qualitative data using chi-square statistical analysis.ResultsAs of the end of January 2016, to 250 parts by cesarean section records collected,250 parts of senile cataract medical records, medical records of 100 cases of acute simple appendicitis,100 parts of uterine fibroids medical records, a total of 750 copies of medical records. Field visits to get a 2011 study to implement a single DRGs Reformation-2015 data related to the overall situation.Preoperative routine examination rate of four kinds of diseases has remained 100% of complete patient data to improve year by year; preoperative other inspection rate index showed acute simple appendicitis disease after the implementation of a single disease payment reform, the indicator drops 5%, and other inspection rate preoperative other three diseases to improve year by year; in terms of diagnostic accuracy, the diagnosis of acute appendicitis disease simple compliance rate in 2014 compared with a 5% decline in 2015, the other three diseases diagnosis rate increased every year; use of antibiotics and the number of days the number of days of hospitalization indicators show overall decline in the number of days of hospitalization, cesarean section and senile cataract disease is decreasing, but simple acute appendicitis and uterine leiomyoma species in a single inpatient implementation after several days of hospitalization in 2012 show an increase in 2013 before slowly decreasing; in postoperative infection rates, simple appendicitis and uterine leiomyoma variations consistent with acute cases, in 2011 and 2012 the infection rate was 5% 2013 years to reach 0 infection. Senile cataract disease prevalence has decreased but there has been some infections; in total medical costs, the implementation of cesarean section after a single DRGs reform, decreasing the total cost of patient care, reduce415.11 yuan in 2013 compared with 2012,2014811.11 yuan decrease compared with 2013, in the same way a single DRGs,2014 and 2015 the average ratio of total health care costs in 2012 and 2013 the average value decreased greatly.ConelusionThrough the study,2011-2015 evaluation of medical quality in four samples of cesarean disease, senile cataracts, acute simple appendicitis, uterine leiomyoma empirical research, after the implementation of the Reform single DRGs, hospitals the overall quality of medical care has improved. First, the total health care costs have decreased significantly, hospitalization days of patients with the use of antibiotics Days overall trend decrease, indicating that medical technology continues to improve, while total health care costs are effectively controlled; secondly, other testing rates before preoperative routine examination and appropriate surgery continues improve, and constantly improve the work shows that hospitals, clinics, diagnostic accuracy of continuous improvement in general, improve the cure rate is also rising, indicating that the overall quality of medical services in hospitals continue to improve; in addition, rising rates of complete patient data, postoperative infection rates gradually reduction, show that hospital medical quality management has been some success.