Background DRGs as the newest payment for medical care, not only considers the complexity and severity of different diseases, but also pays attention to the medical needs and resource intensity.
Objective To explore the application effect of DRGs based data analysis in hospital performance evaluation.
Methods A total of 123 591 medical insurance cases discharged from a tertiary general hospital (Hospital X) from January to October in 2015 were included in the study. The inpatient medical service ability and construction of specialty ability were the focus of calculation. The number of DRGs, case mix index, cost consumption index, time consumption index, low and medium risk mortality were selected as the measurement indexes. Another 10 000 medical insurance cases from a Tertiary General Hospital were selected for comparison, so as to foster learning about the current situation of our medical services, utilization of medical resources, and the quality of medical treatment.
Results Of the 123 591 cases in 2015, there were 113 402 cases enrolled, with an enrollment rate of 91.7%. The number of DRGs in Hospital X was 751, with CMI of 1.21, cost consumption index of 1.40, time consumption index of 0.98, low-risk mortality of 0.01%, and medium-risk group mortality of 0.10%, while the data in the Benchmarking Hospital were as follows: 639, 1.34, 1.20, 0.84, 0, 0.09%. Compared with the Benchmarking Hospital, Hospital X had more DRG groups, lower CMI, higher cost and time consumption index, and higher low-risk and medium-risk of mortality.
Conclusion By comparing with Benchmarking Hospital, we conclude that the breadth of disease diagnosis and treatment in Hospital X is high, the medical technical difficulty is low, despite the well-controlled of average length stayed in hospital, the cost is still high in most of disease groups. On the condition that the basic policies remain unchanged, the hospital should use DRGs method for evaluation, which can provide better methods and available thoughts for hospital operation.
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