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Objective@#To study the preoperative blood glucose management model and its implementation effect in the multidisciplinary team of ophthalmology under the background of diagnosis related groups (DRGs).@*Methods@#A total of 170 patients underwent vitrectomy, vitreous injection, and cataract extraction surgery were enrolled in the CS03Z and CS09A groups from January 1, 2018 to December 31, 2018. The cases from January 1, 2018 to June 31, 2018 were in the control group, accounting for 76 cases, and routine blood glucose management was performed. The cases from July 1, 2018 to December 31, 2018 were observed in the observation group, and 94 cases were implemented. The multidisciplinary blood glucose management model was implemented. The average hospitalization days, average hospitalization costs, preoperative blood glucose management quality, and hospitalization satisfaction were compared between the two groups.@*Results@#In the control group, the average hospitalization cost of the three operations (PPV/IV/Phaco group) was (13 949.71±2 099.36) yuan, (4 933.22±2 269.33) yuan, (6 521.16±1 006.40) yuan, the average hospitalization cost of the three operations of the observasion group was (12 937.37±1 447.33) yuan, (2 649.53±1 105.92) yuan, (5 315.76±1 037.02) yuan, the difference between the two groups was statistically significant (t=2.266, 3.818, 4.074, all P<0.05 or 0.01) . The average hospitalization day of the 3 operation group was (9.98±3.91) d, (9.63±5.46) d, (7.65±3.88) d, and the observation group was (6.37±3.54) d, (3.97±2.29) d, (4.17±2.23) d,the difference between the two groups was statistically significant (t=3.980, 3.979, 3.632, all P<0.01). The preoperative blood glucose accident rate in the control group was 14.47% (11/76), The observation group was 2.13% (2/94), the difference between the two groups was statistically significant (χ2=11.642, P<0.01). The surgical delay rate of the control group was 2.63% (2/76) ; the surgical delay rate of the observation group was 0(0/94), the difference between the two groups was statistically significant (χ2=7.045, P<0.01) .The nurse blood glucose management of the control group was 66.67% (24/36) , and that in the second half was 97.22% (35/36) ,the difference between the two groups was statistically significant (χ2=9.005, P<0.01). The satisfaction rate of the patients in the control group was 82.89% (63/76), and that of the observation group was 94.68% (89/94). the difference between the two groups was statistically significant (χ2=6.166, P<0.05).@*Conclusion@#Under the background of DRGs, the preoperative multidisciplinary blood glucose management team with clinical pathway as the core can effectively reduce the average hospitalization cost and average hospitalization day, improve the quality of blood glucose management, and improve the hospitalization satisfaction of the patients.
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Objective To screen TCM dominant diseases from service efficiency, service quality and security by taking a three-A-grade TCM hospital as example.Methods According to the diagnosis related data of the TCM hospital, the common diseases in major disease categories (MDC) were screened out. Average cost of hospitalization, average hospitalization days, antibiotic use rates, blood use rates, and mortality rates were compared with the average level of tertiary general hospitals.Results Totally 27 common diseases were screened out. Three diseases had advantages in terms of service efficiency, security and service quality; 14 diseases had security advantage; 13 diseases had advantage in service quality.Conclusion Compared with three-A-grade general hospitals, most of the common diseases in the hospital has obvious advantages in security and service quality, but the average length of hospitalization in the hospital is longer, and the average cost of most of the common diseases is higher than the general hospital, without advantages in service efficiency.
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DRGs is one of the most advanced methods of payment in the world.It can control the unreasonable growth of medical expenses to a certain extent.China has also began to explore DRGs payment methods,and has tried to play an active role in medical insurance cost control.Compared with foreign DRGs,Chinese DRGs has a unique cost control mechanism,and its cost control effect will be affected by many environmental variables.
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A large size tertiary comprehensive hospital designed the performance reform program not only based on RBRVS and DRGs but also combined with cost control and medical quality and safety. The hospital have implemented performance reform at 2016, with achieving the public welfare and fairness by "combination" and exploring a set of performance management methods which suit the hospital's actual condition and boost its development.
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OBJECTIVE:To investigate the effects of clinical pharmacists participating in the implementation of clinical path-way under the condition of disease diagnosis related groups-prospective payment system(DRGs-PPS),and to provide reference for promoting rational drug use in the clinic. METHODS:Patients with femoral neck fracture in the clinical pathway were collected from our hospital as research objects. The patient collected during Jan.-Dec. 2015 were included in control group(52 patients includ-ed,41 patients completed)and those collected during Jan.-Dec. 2016 were included in observation group(58 patients included,46 patients completed). Clinical pharmacists participated in the implementation of clinical pathway in observation group,and provided technological intervention and administrative intervention. No intervention was performed in control group. Hospitalization time, hospitalization cost,drug cost and ADR were observed in 2 groups. The rationality of antibiotics for prophylactic use,analgesic drugs,adjuvant drugs,anti-osteoporosis drugs and anticoagulant were compared between 2 groups. RESULTS:After clinical pharma-cists participating in the implementation of clinical pathway in observation group,there was no statistical significance in hospitalization time or the incidence of ADR between 2 groups(P>0.05); hospitalization cost and drug cost of observation group were significantly lower than those of control group,with statistical significance(P<0.05). Medication time and cost of antibiotics for prophylactic use,cost of analgesic drugs,medication time of adjuvant drugs in observation group were significantly shorter/lower than control group;type of anti-osteoporosis drugs was significantly more than control group,with statistical significance(P<0.05). CONCLUSIONS:Under DRGs-PPS,the participation of linical pharmacists participating in the implementation of femoral neck fracture clinical pathway can play an important role in regulating the clinical rational use of 5 kinds of drugs and ensuring the safety,effectiveness and econom-ics of drug use.
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Presented in the paper are the Patient Clinical Complexity Level(PCCL)and Episode Clinical Complexity(ECC)models as used in Australia.Comparison of the differences between ECC model and PCCL model,and a replacement of ECC model of PCCL model in measurement of disease complexity,points the way for localized scheme design in China.
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BJ-DRGs grouping process was cited as an example, to describe the factors affecting the grouping process, grouping results and assessment results, and the solutions in transferring homepages into WJT form 4-1 for inpatient medical record homepages (WJT form 4-1 for short).Authors analyzed how to better information acquisition quality of such homepages by unifying the data interface standard of WJT form 4-1, for the purposes of enhancing BJ-DRGs grouping efficiency, and expanding its functions as a tool for medical quality management and that for medical insurance payment management.
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DRG-based prospective payment system ( DRG-PPS ) is one type of mature inpatient care payment mechanisms in most countries and pilot projects would be introduced to China in 2017. This article provides an overview of the previous typical DRG-PPS reform initiatives on provincial, municipal and county level respectively. It also summa-rizes the characteristics of the reform programs, describes the diversities of policy implementation, and discusses the suc-cessful experience and implications of the initiatives. The paper puts forward some suggestions on the upcoming DRG-PPS pilot projects based on the progress and problems of the initiatives, to promote the DRG-PPS reform in China.
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This paper analyzes the reform backgrounds, mechanisms and measures of financing and payment taken in the second-generation national health insurance (NHI) in Taiwan. The results indicate that in 2nd NHI, the rate was adjusted more flexibly, supplementary insurance premium was charged to enlarge the financial source by im-plicating additional subsidies and expanding the sources of financing, multiple payment methods and auxiliary assis-tive means were used to control the growth of medical expenses, social insurance payments are specified in terms of category or clear payment projects and standards, new health technology assessments are used as new basis for deci-sion making, etc. by greatly alleviating the financial deficit, which helped achieve the financial balance again. Many features of the 2nd NHI in Taiwan, especially like its diversified financial resources and financing methods, global budget of control fees and DRGs payment systems, making evaluation criteria for medical quality control and health insurance reimbursement project development and so on, are worth learning for the mainland China.
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Objective To study the calculation of the cost consumption index adjusted with major diagnostic classification (MDC), for optimal use of DRGs index in hospital performance evaluation. Methods The adjustment method of CMI value in DRGs index system was used as reference, and we compared the different cost consumption indexes(both MDC adjusted and non-adjusted) of two hospitals(S and Y) in Guangdong province. Then we compared the different rankings of 82 tertiary general hospitals in the province before and after the adjustment. Results The cost consumption index of S hospital was higher than that of Y hospital by the non-adjusted method (1.30 >1.28). But as calculated by the adjusted method,the index of S hospital was significantly lower than Y hospital (1.31 <1.38). The rankings of these 82 hospitals also showed major changes,which prove that the cost consumption index, the same as CMI,will be affected by MDC cases makeup.Conclusions The MDC adjusted cost consumption index, when applied to hospital performance evaluation, renders more stable and reasonable results. This is an evidence that the adjusted cost consumption index is of great practical value in hospital performance evaluation.
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Objective To investigate the application and feasibility of the single bed work efficiency in the evaluation of hospital beds efficiency,to establish the hospital beds efficiency evaluation model,in order to provide the basis for scientific and effective utilization and evaluation of beds.Methods Proposing the concept of single bed work efficiency,establishing a new evaluation model of bed efficiency,and analyzing the utilization of hospital beds in 2015.Results Single bed work efficiency is supenor to other indexes in evaluating the Utilization efficiency of hospital beds,and the new bed efficiency evaluation model is more objective and accurate.Conclusion The evaluation model of hospital beds utilization efficiency based on the single bed work efficiency is more comparable and operable,which can be widely used in hos pital delicacy management.
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Objective To analyze and compare the capacity and efficiency of county-level hospitals′medical service by using the diagnosis related groups ( DRGs ) method. Methods The homepage data of discharged inpatients from seven county-level hospitals in Wenzhou region in 2013 - 2015 period were analyzed, for measurement of the medical service capacity changes of such hospitals using the number of DRGs, total multiplicity of weight, and CMI value, and that of their medical service efficiency changes using expense consumption index and time consumption index. Results The study found in the seven hospitals 8. 49% increase of the total number of DRGs, 17. 34% increase of total multiplicity of weight, and 5. 06%increase of CMI value, with unchanged expense consumption index and 9. 82% decrease of the time consumption index. These facts evidenced enhancements of these hospitals in both service capacity and service efficiency in general. Conclusions DRGs as tools prove useful objectively and scientifically. Policies of Two emphases at primary ends and two enhancements have been implemented desirably.
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As introduced in the paper, the average days of stay of clinical department were calculated as a management target, in view of the complexity of disease and case mix index. This method could avoid the deficiency of traditional methods and make the management of average length of stay of clinical department more conforming to the actual situation, and also more scientific and reasonable.
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The authors probed into the application and feasibility of DRGs in improving the efficiency and quality of hospital medical services,in order to establish a lean management mode based on DRGs.DRGs are seen as different from other means of management,with such evaluation of medical services being more comparable and operable,and the evaluation results more trustworthy.Application of such practice can obviously improve the efficiency and quality of medical services,making it widely applicable to hospital′s lean management.
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Discussed in the paper are case-based payment practice in China,and outcomes of this practice for the past ten years.The authors pointed out that compared with DRGs,such a practice is exposed to such risks as low coverage of diseases,incompatible policies,defective pricing method,and lack of comprehensive evaluation.It indicates that China is on the initial stage of case-based payment reform which should be promoted with reference to international experiences.
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Objective To explore the use of Diagnosis Related Groups(DRGs)evaluation index in performance management system of hospitals.Methods The performance evaluation system was built based on medical business volume index,efficiency indicators,cost control indexes,drug control indexes, medical quality and medical safety indexes,by means of extracting the home page of hospital discharge records from 2009 to 2013 and grouping automatically with the“BJ-DRGs”group-maker.Results The operation evaluation indexes of the hospital have seen great progress since advent of the DRGs evaluation indexes.Conclusion Introduction of DRGs has scored great success in the performance appraisal system of the hospital.
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Based on the Australian AR-DRGs, this research gathered the diagnosis related information on the first page of medical records and accomplished the computerization of data collection and analysis through the data-base of Shanghai Shenkang Hospital Development Center.According to the clinical practices, the DRGs model has been adjusted to complete the localization and a severity-based-DRGs model and grouping tool have been established for the municipal hospitals in Shanghai.
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Introducing the progress of DRGs work in Beijing, its application in medical insurance payment, as well as in hospital management and appraisal.Recommendations were made for DRGs development in the country, including unification of DRGs standards nationwide, orchestrated efforts of government departments, and acceleration of DRGs use in payment mode reforms.
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With performance evaluation management as the stepping stone,the hospital joined the DRGs with the attending in-charge method by means of enforcing the attending in charge practice,DRGs knowledge training,and identifying problems with DRGs grouped data of the attending physician group, in an effort to explore new methods of medical quality control.Two years of practice provide tools of quality control to strengthen the hospital’s fine management.At the same time,it should also be noticed that DRGs merely diversify management means,as the content and form of which still need to constantly be improved in the course.
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Objective Analyze the causes of ambiguous medical records to provide evidence for the DRGs.Methods 268 Ambiguous medical records were selected from 17 751 surgery medical records between 2010 and 2014 based on major diagnosis and major surgery.The single factor Chi-square test was used to study the influence of various inpatient characteristics on the occurrence of ambiguous medical records, and those significant variables were given assignment to find influencing factors of ambiguous medical records by using logistic regression analysis.Results Ambiguous medical records account for 1.51％ of all surgical medical records.Logistic regression analysis results show that such risk factors as discharging from internal medicine, death of patient, transfer between departments, elderly, long time of hospitalization, and tumor patients, as contributing to ambiguous medical records.All the results are statistically significant (P＜0.05), including discharging from which departments (OR=6.595, 95％CI..5.043 ～ 8.625), death of patient (OR=3.787, 95％ CI: 2.611 ～ 5.492) and transfer between departments (OR =2.746, 95％ CI: 2.061 ～ 3.659), which rank important risk factors for ambiguous medical records.Conclusion Analysis of the causes of ambiguous medical records provides important evidences for the hospital to improve its medical record quality management.