Research On The Comprehensive Effect Of Medical Service Quality Based On DRG

ObjectiveThe quality of medical services is the core and key to the quality of the work of medical institutions,and it is also an important guarantee for improving people’s health.An objective and fair comprehensive evaluation has important practical significance for the quality of hospital medical services and for hospital managers to improve the quality of medical services.However,due to the diversity and randomness of medical needs in the medical system,as well as the asymmetry of medical information,it is difficult for the government to rationally evaluate,supervise and guide the diagnosis and treatment of different cases when managing public hospitals.In order to solve this problem,internationally,case mix tools are often used to adjust the risk of cases to ensure that the evaluation results are more reliable.Among them,the most widely used is the Diagnosis Related Groups（DRG）.After New Jersey took the lead in implementing DRG payment in 1983,many countries such as Australia,Germany,and the United Kingdom successively implemented it.China also successfully developed BJ-DRG in 2008.With the continuous advancement of China’s DRG,the impact of DRG implementation on the quality of medical services has become the focus of common concern in academic circles and society at home and abroad,especially the effect of implementation.Some domestic documents use interrupted time series to evaluate the effect of DRG implementation,but most of them use a single indicator to analyze the changes before and after the DRG reform,and rarely documents pay attention to the changes before and after the comprehensive effect.Based on this,this paper uses the time series data of 3 different types of public hospitals,and on the basis of constructing a comprehensive effect evaluation index system of medical service quality based on DRG,aiming to explore the comprehensive effect of DRG reform on medical service quality.The comprehensive effect change trend provides a basis for health managers to formulate the next improvement measures.Methods1.Comprehensive Evaluation Method:Based on the theory of hospital management performance,refer to the existing research literature and field surveys to determine the primary indicators of DRG medical service quality;the delphi method was used to screen the indicators,and 30 experts from hospitals,universities,and scientific research institutions were consulted to determine the indicators on all levels of indicator scoring and modification opinions,and the analytic hierarchy process was used to calculate the weight of each indicator.Then,on the basis of consulting experts,the DRG-based comprehensive effect evaluation index system of medical service quality is finally formed.2.Interrupted Time Series Analysis Method and Comparative Approach Method:Based on the 2013-2019 quarterly data from the medical record homepages of 3hospitals in Shanghai and the semi-annual data from the 2016-2019 medical service information publicity,the 2017 intervention point was used as the DRG implementation point,and the impact of the DRG policy on the quality of medical services was interrupted.Time series analysis aims to explore the level changes and trend changes of various observation indicators of medical service quality before and after the implementation of DRG.At the same time,based on the results of comprehensive evaluation and intermittent time series analysis,the differences between the three hospitals in different periods and the same period were compared.Results1.Construction of the comprehensive effect evaluation index system of medical service quality based on DRGBased on the research literature of DRG medical service quality at home and abroad,using hospital management performance theory,combined with field research,through index selection and empowerment,using DRG basic indicators as key indicators,constructing DRG-based comprehensive effect evaluation indicators for medical service quality.The system includes four dimensions of medical service capacity,medical service efficiency,medical quality and safety,and disease structure monitoring.2.Empirical research results（1）Comprehensive evaluation results of medical service quality based on DRGMedical service capacity:The scores of central hospitals are always higher than those of traditional Chinese medicine and women’s and children’s hospitals;compared with before the implementation of DRG,the three hospitals have improved after the implementation of DRG.In terms of growth rate,the average annual growth rate of women and children and central hospitals both declined slightly.In terms of trends,the three hospitals showed an overall upward trend.Medical service efficiency:After the implementation of DRG,the central hospital scored the highest;compared with before the implementation of DRG,both traditional Chinese medicine and central hospitals have improved after the implementation of DRG,while the women and children’s hospitals have slightly decreased.In terms of growth rate,the growth rates of the three hospitals all increased.In terms of trends,the medical service efficiency of the three hospitals generally showed a downward trend and then an upward trend.Among them,traditional Chinese medicine and central hospitals have experienced significant increases after the implementation of DRG.Medical quality and safety:The scores of women’s and children’s hospitals are the highest before and after the implementation of DRG;compared with before the implementation of DRG,both traditional Chinese medicine and central hospitals have slightly increased.In terms of growth rate,the growth rate of Chinese medicine hospitals has declined,and the growth rate of central hospitals has slowed down.In terms of trends,traditional Chinese medicine hospitals showed a slight upward trend after the implementation of DRG.Central hospitals first declined and then increased and there was a seasonal pattern.Women and children hospitals showed no obvious changes and did not show a linear trend.Disease structure monitoring:The scores of central hospitals are always higher than those of traditional Chinese medicine hospitals;compared with before the implementation of DRG,both traditional Chinese medicine and central hospitals have declined after the implementation of DRG.In terms of growth rate,the decline of the growth rate of traditional Chinese medicine hospitals has slowed down,and the decline of the growth rate of central hospitals has accelerated.On the trend,the monitoring of the disease structure in the center and the women’s and children’s hospitals has shown a downward trend.（2）Intermittent time series analysis resultsMedical service production capacity:After the implementation of DRG,the hospital medical service production capacity decreased（β₂<0）,and the slope increased（β₃>0）,but there was no statistical significance.From the perspective of three different types of hospitals,the level of traditional Chinese medicine and central hospitals has also declined,and the slope has increased;women and children hospitals have seen levels of rise,and the slope has fallen.The above-mentioned only the slope of traditional Chinese medicine hospitals is statistically significant（P<0.05）.Medical service efficiency:After the implementation of DRG,the hospital medical service efficiency decreased（β₂<0）,and its slope increased（β₃>0）,and it was statistically significant（P<0.05）.From the perspective of three different types of hospitals,the medical service capacity of traditional Chinese medicine,women and children,and central hospitals declined after the implementation of DRG,and then the slope changed from a slight decline to a rapid increase.Only Chinese medicine and central hospitals had statistical significance（P<0.05）.Medical quality and safety:After the implementation of DRG,the level of medical quality and safety decreased（β₂<0）,and the slope increased slightly（β₃>0）,but there was no statistical significance.From the perspective of two different types of hospitals,the level of traditional Chinese medicine hospitals increased after the implementation of DRG,and the slope increased;the level of central hospitals decreased,and the slope increased,but the above changes were not statistically significant.ConclusionsAfter demonstrating the DRG-based medical service quality of 3 different types of hospitals in Shanghai,the effect of issuing DRG on medical service quality has achieved initial results,especially in terms of medical service efficiency.The specific manifestations are as follows:First,DRG is slightly effective in medical service production capacity,which has a positive impact on the medical production capacity of Chinese medicine hospitals.The second is that the implementation of DRG has different effects on the efficiency of medical services in various hospitals,and the overall feedback is positive.The third is that the implementation of DRG has prompted hospitals to shorten the length of stay and control the unreasonable increase in medical expenses.But at the same time,there are still some problems in the implementation of DRG:First,the implementation of DRG has not had a significant effect on medical quality and safety;second,the number and depth of services in individual hospitals need to be improved,and there may also be unexpected behaviors in selecting patients;Third,the ability to carry out diagnosis,treatment and operation of difficult diseases needs to be improved,and the service ability and hospitalization time of representative diseases need to be improved.Based on the above conclusions,the following suggestions are made from the perspective of health departments and hospitals:（1）Strengthen the management of medical records and improve the quality of DRG data;（2）Use service efficiency as the starting point to improve the quality of DRG medical services;（3）Improve Disease diagnosis and treatment and surgical capabilities to consolidate the functional positioning of the hospital;（4）Improve DRG supporting measures to improve the quality of medical services.