| Objectives:The use of traditional DRGs index and two index for the evaluation of medical service of hepatopancreat obliliary in a hospital in Yunnan Province,the Institute of hepatopancreat obliliary,group A,B,C three wards in the medical service capacity,efficiency and security dimensions of current situation of medical service and the traditional DRGs index and the evaluation results;understanding of hepatopancreat obliliary in three wards of disease,hospitalization time and hospitalization expenses,hospitalization time and hospitalization cost factors to understand the influence of DRGs packet conditions.analysis of the advantages and disadvantages of traditional index and DRGs index in the evaluation of medical service,to understand the current situation of medical service departments from multidimensional angle index data,provide the basis for the Department to improve medical efficiency and for efficiency,DRGs index is used to guide the Department of scientific management will lay the foundation for DRGs,the parameters related to the management of medical service for the hospital to explore,to achieve fine and provide reference for improving the level of medical service.Methods:Three cases of hepatopancreat obliliary in the hospital were selected as the object of study.The data of the patients' discharge from January to December of 2016 in the hepatopancreat obliliary of the hospital were collected,and the data of DRG packets in a certain platform were collected,the traditional DRG index and related data in three dimensions of ability,efficiency and safety,and the comprehensive evaluation the data processing method and comprehensive index method in the evaluation;using hierarchical analysis of the structural weight of three endemic disease,and the patients accounted for more than 80%of the disease were analyzed by frequency analysis,to understand the distribution of diseases;selection of hepatopancreat obliliary overall top five diseases,understanding the hospitalization time and hospitalization expenses the hospitalization time,and further analysis the influence of DRGs packet conditions and factors of the hospitalization expenses.Statistical analysis into SPSS 19.0 software for data check,according to data Data categories,distribution characteristics and analysis purposes,mainly using statistical methods,including descriptive statistical analysis,chi 2 test,analysis of variance,correlation analysis,with P<0.05 as the difference,with statistical significance.Results:1.Results of medical performance service evaluation in three wards of hepatopancreat obliliary:the results of traditional index performance evaluation:a ward ranks first,B ward ranks third,and C ward ranks second.The ability index was ranked:A ward(1.13)?B ward(0.96)?c ward(0.91);the efficiency index was ranked:C ward(1.27)?B ward(1.15)?a ward(0.82);the safety composite index was ranked:A ward(1.39)?C ward(1.07)?B ward(0.83).DRGs indicators for performance evaluation results:a ward ranked one,B ward ranked third,C ward ranked two.The ability index was ranked a in descending order(1.23)?The ability index was ranked:a ward(1.23)?C ward(0.96)?B ward(0.87);the efficiency index was ranked:C ward(1.27)?B ward(1.15)?A ward(0.82);the comprehensive index of medical service safety was 0 in three wards.The results of the comprehensive evaluation of the traditional and DRGs indexes are consistent,and there are some differences in different dimensions.2.The structure of hepatopancreat obliliary:three ward between plants difficult layered statistical analysis results:difficulty for W?1.0 level:x2=5.583,P<0.061;Difficulty 1.0<W?2.0 levels:x 2= 7.215,P<0.027;Difficulty for W>2.0 level x 2?7.165,P<0.028,three units in W?1.0 levels between diseases there was no statistically significant difference in the number of hospital,between three ward in 1.0<W?2.0 and W>2.0 two levels diseases discharge number difference had statistical significance.at 1.0<W?2.0 within the scope of the diseases of descending order is:A ward 432(37.76%),B ward 398(34.79%),C ward 314(27.45%);Within W>2.0 disease accounted for than descending order is:A ward 344(41.40%),B ward 238(28.64%),C ward 249(29.96%).Three units were disease in low difficulty level disease proportion is very high,a ward of the hospital patients for 2076(72.80%);The numBer of patients discharged from hospital B was 1799(73.88%);The number of patients discharged from the hospital in C was 1752(75.68%).3.The specific distribution of diseases in the three wards of hepatopancreat obliliary:A,B,C,the disease areas were mainly related to gallbladder,pancreas,liver resection,related diseases,and other biliary and pancreatic related diseases.The A ward was in HD15(37.48%)?HB15(48.16%)?HD13(35.37%)?HR15(42.75%)?HZ15(41.86%)?RU14(65.56%)HL13 and HJ15 accounted for the highest proportion of the eight diseases;the B ward was in HZ25(37.79%)?HZ23(43.16%)?HT15(48.57%)?HC25(53.41%)and HC23(44.58%)had the highest proportion of the five diseases,and the C ward was HC19(53.19%)the proportion of the three diseases is the highest.4.The cost of hospitalization in three wards of hepatopancreat obliliary:the hospitalization expense statistics between three wards were F=10.599,P<0.005,the difference was statistically significant;the hospitalization expense statistics in HD 15 between three wards were F=150.431,P<0.0001,the difference was statistically significant;the hospitalization expense statistics in HB15 between three wards were F=33.584,P<0.0001,the difference was statistically significant;the hospitalization expense statistics in HD 13 between three wards were F=30.452,P<0.0001,the difference was statistically significant;the hospitalization expense statistics in HZ25 between three wards were F= 10.791,P<0.000 1,the difference was statistically significant;the hospitalization expense statistics in HR15 between three wards were F=33.584,P<0.0001,the difference was statistically significant.5.The time of hospitalization in three wards of hepatopancreat obliliary:the hospitalization time statistics between three wards were F=71.398,P<0.0001,the difference was statistically significant;the hospitalization time statistics in HD 15 between three wards were F=71.131,P<0.0001,the difference was statistically significant;the hospitalization time statistics in HB15 between three wards were F=5.701,P<0.004,the difference was statistically significant;the hospitalization time statistics in HD 13 between three wards were F=0.744,P<0.476,the difference was statistically significant;the hospitalization time statistics in HZ25 between three wards were F= 1.248,P<0.288,the difference was statistically significant;the hospitalization time statistics in HR15 between three wards were F=5.701,P<0.004,the difference was statistically significant.6.The analysis of the influence factors of hospitalization expenses and hospitalization time showed that the hospitalization expenses and the weight were moderately positive(r=0.642,P<0.0001),There was a low positive correlation between hospitalization expenses and death risk(r= 0.247,P<0.0001),and there was a low positive correlation between hospitalization expenses and complications(r=0.139,P<0.0001);Hospitalization time and weight were positively correlated(r=0.581,P<0.0001),hospitalization time and mortality risk was low positive correlation(r=0.259,P<0.0001),hospitalization time and no complications was low positive correlation(r=0.166,P<0.0001).Conclusions:1.DRGs indicators applied to the medical performance evaluation has a certain feasibility and scientific,on the one hand,with professional classification,weight system,benchmarking and other aspects of the advantages,on the other hand,china has been on DRGs for many years,related policies and supporting Tools have been gradually improved for the DRGs indicators to carry out hospital medical service evaluation laid the foundation.2.The traditional indicators and DRGs indicators for medical service performance evaluation results there are some differences,DRGs indicators based on disease differences pay more attention to the evaluation of medical services "quality",for medical units between the medical services comparison,can objectively reflect the hospital The status of internal medical services.3.according to the comprehensive evaluation results of DRGs,we can see that the a ward has the best performance in the medical service,and the C ward of the ward is the second.a ward has the best performance in terms of medical service capacity and safety,while the efficiency of medical services remains to be improved,and the C ward has performed optimally in terms of efficiency in health care.A And B wArd should be further strengthened in hospitalization and hospitalization controls.4.The three wards of hepatopancreat obliliary in the treatment of diseases are mainly difficult to the main disease,the diagnosis and treatment of difficult diseases concentrated in the A ward,B ward in the proportion of difficult to diagnose the disease is higher than the C ward,C ward in the diagnosis and treatment of difficult disease is higher than the B ward.A,B,C wounds were gallbladder,pancreatic,hepatectomy-related diseases,and other biliary and pancreatic-related diseases,and in the hepatobiliary and pancreatic malignant tumor disease is relatively concentrated in the A ward,total bile duct surgery is concentrated In the C ward.5.The weight of the disease,the risk of death,and whether the complications were associated with hospitalization costs and hospitalization time,indicating that the difficulty of disease diagnosis and treatment for the diagnosis and treatment of the process of resource consumption has a great impact,proved that the difficulty of diagnosis and treatment of different departments Medical service evaluation is very necessary,DRGs indicators to assess the extent of disease diagnosis and treatment of patients based on the difficulty of making up for the traditional indicators in this area deficiencies.6.To further promote the evaluation of DRGs medical services,according to the actual development of the situation to further improve the quality of the first page of the data,to promote DRGs subcontractor to further mature,promote DRGs optimization and development,the use of DRGs tools to guide medical institutions to improve the level of medical services. |
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