健康发展与政策研究2025，Vol.28Issue(2)：186-192,7.DOI:10.12458/HDPR.202410052
基于技术劳务指数的DRG病组精细化管理策略研究:以上海某三级甲等医疗机构为例
Refined management strategies for DRG groups based on the technical labor value index:a grade 3A hospital case in Shanghai
摘要
Abstract
Objective This study takes a tertiary Grade A hospital in Shanghai as an example to conduct a comprehensive evaluation of disease groups under the DRG system,exploring refined management strategies.Methods Cases within the DRG settlement scope of a tertiary Grade A hospital in Shanghai in 2021 were selected as the research subjects.The study utilized 3 indicators-the case mix index(CMI),medical insurance payment rate,and the newly introduced technical labor index-to conduct an in-depth analysis of the complexity,economic benefits,and resource consumption of each disease group.Based on these indicators,the key disease groups in the hospital were classified into 8 categories,and specific management strategies were proposed for each category.Results A total of 100 disease groups and 36 011 cases were included.The study identified 3 main issues:the quality of medical records needed improvement;the proportion of low-complexity disease groups was relatively high;and the scale of cost overruns was significant,with suboptimal cost structures in some disease groups.According to the characteristics of different categories of disease groups,corresponding management strategies were proposed.For example,dominant disease groups should continue to receive support,with a focus on strengthening key specialty development;potential disease groups require optimization targeting weak indicators;vulnerable disease groups should prioritize improving one relatively easier-to-enhance weak indicator;and disadvantaged disease groups need in-depth analysis of causes and issues,followed by corrective measures.Conclusions Hospitals should leverage the value of technical labor as a key driver to optimize disease group structures,strictly control the use of pharmaceuticals and consumables,strengthen information system construction and medical record management,and refine incentive and restraint mechanisms to enhance the development momentum of clinical departments.Additionally,specialized task forces should be established to strengthen cross-departmental collaboration,ensuring the comprehensive implementation of DRG management.This will facilitate the transition of hospitals from scale expansion to quality and efficiency improvement,achieving high-quality,connotative development.关键词
疾病诊断相关分组/病组管理/精细化管理/病例组合指数Key words
diagnosis related group/disease classification management/refined management/case mix index(CMI)分类
医药卫生引用本文复制引用
张毅,王馨慧,刘明,李僔逸,王晓影,金文忠,陆文良..基于技术劳务指数的DRG病组精细化管理策略研究:以上海某三级甲等医疗机构为例[J].健康发展与政策研究,2025,28(2):186-192,7.基金项目
上海市加强公共卫生体系建设三年行动计划公共卫生监管数字化服务和应用能力提升项目(GWVI-5) （GWVI-5）
上海交通大学医学院附属第九人民医院2023年院级重点课题(YGA202306) （YGA202306）
