甘肃省分级诊疗制度下药占比合规性研究
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摘要
目的探讨分级诊疗政策环境下,住院患者可比药占比情况,总结其变化规律,为甘肃省全面推进药品零差率提供科学依据。方法抽取2017年甘肃省新农合住院患者信息,采用传统数据统计方法和大数据挖掘相结合的方法,分析药品价格信息。结果分级诊疗政策对于住院患者可比药占比的控制效果不明显,分级诊疗政策环境下住院患者的可比药占比有自身特点,老年人可比药占比的合理性较差。结论应完善分级诊疗政策,真正实现"三医联动"。将DRGs方法应用到可比药占比的控制中,并积极与其他医改政策实现联动。
Objective To explore the proportion of comparable drugs in inpatients under the policy environment of graded diagnosis and treatment,and summarize its changing rules,so as to provide scientific basis for comprehensively promoting the drug zero difference rate of public hospitals in Gansu province. Methods The information of hospitalized patients in Gansu Province in 2017 was extracted.The traditional data statistics method and big data mining method were combined to analyze the drug price information. Results The hierarchical diagnosis and treatment policy had no obvious effect on the proportion of comparable drugs in inpatients.The proportion of comparable drugs in inpatients under the hierarchical diagnosis and treatment policy had its own characteristics,and the proportion of comparable drugs among elders was poorer. Conclusion The hierarchical diagnosis and treatment policy should be improved to truly realize the "three medical linkages".The DRGs method can be applied to the control of comparable drugs proportion and actively link with other health care reform policies.
Objective To explore the proportion of comparable drugs in inpatients under the policy environment of graded diagnosis and treatment,and summarize its changing rules,so as to provide scientific basis for comprehensively promoting the drug zero difference rate of public hospitals in Gansu province. Methods The information of hospitalized patients in Gansu Province in 2017 was extracted.The traditional data statistics method and big data mining method were combined to analyze the drug price information. Results The hierarchical diagnosis and treatment policy had no obvious effect on the proportion of comparable drugs in inpatients.The proportion of comparable drugs in inpatients under the hierarchical diagnosis and treatment policy had its own characteristics,and the proportion of comparable drugs among elders was poorer. Conclusion The hierarchical diagnosis and treatment policy should be improved to truly realize the "three medical linkages".The DRGs method can be applied to the control of comparable drugs proportion and actively link with other health care reform policies.
引文
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[2]余波,江学成,张玉西.医院药占比控制体会[J].解放军医院管理杂志,2011,18(1):80-81.
[3]王岩.强化药事管理合理降低医院药占比[J].中国药导报,2013,10(16):167-169.
[4]周国朝,陈勇,石志凤.公立医院源头控制"药占比"的实践与会[J].中国医学伦理学,2012,25(6):739-741.
[5] Joseph S G,Mark C H,Daniel Z L.Staging of disease[J].JMMA,1984,251(5):637.
[6] Stephen F Jencks,Allen Dobson.Refining Case mix adjustment[J].N Eng J Med,1987,317(11):679-681.
[7]闫宣辰,姚进文,路杰.甘肃省分级诊疗政策的探讨[J].甘肃医药,2017,36(12):1071-1073.
[8]国务院.国务院关于印发"十三五"深化医药卫生体制改革规划的通知[J].中华人民共和国国务院公报,2017(3):66-81.
[9]刘远立.深化医改要符合科学发展规律[J].行政管理改革,2015(3):17-22.
[10] Fetter R B,Shin Y,Freman J L,et al.Case Mix Definition by DiagnosisRelated Groups[J].Medical Care,1980,18(2):1-53.
[11]中国医学科学院医学信息研究所,美国国立医学图书馆.医学主题词注释字顺表(2002年版):英汉对照[M].北京:中国计量出版社,2002:9.
[12]简伟研,胡牧,张修梅.诊断相关组(DRGs)的发展和应用[J].中华医院管理杂志,2011,27(11):817-820.
[13]郭永瑾,岑珏,许岩,等.疾病诊断分组系统的建立及其在医院绩效管理中的应用[J].中国卫生政策研究,2015,8(9):6-9.
[14]国家卫生计生委.医疗质量管理办法[EB/OL].(2016-09-25)[2017-05-01].http://www.nhfpc.gov.cn/fzs/s 3576/201610/ae125f28eef24ca7aac57c8ec530c6d2.shtml.
[15]Mac lure M.The case-secular study design and counterfactual controls[J].Epidemiology,1998,9(1):6-7.
[16] Isett K R,Laugesen M J,Cloud D H.Learning from New York City:a case study of public health policy practice in the Bloomberg administration[J].J Public Health Manag Pract,2015,21(4):313-322.
[17]Halloran M E,Hudgens M G.Dependent Happenings:A Recent Methodological Review[J].Curr Epidemiol Rep,2016,3(4):297-305.
[18] Ewusie J E,Blondal E,Soobiah C,et al.Methods,applications,interpretations and challenges of interrupted time series(ITS)data:protocol for a scoping review[J].BMJ Open,2017,7(6):16-18.
[19] Jandoc R,Burden A M,Mamdani M,et al.Interrupted time series analysis in drug utilization research is increasing:systematic review and recommendations[J].J Clin Epidemiol,2015,68(8):950-956.