Application effect of refined management in day surgery based on diagnosis-related groups_West China Medical Journal

Authors：

WANG Dan ¹ , XIE Ping ¹ , ZHENG Chufa ¹ , LI Lixuan ¹ , HONG Chunyan ² , YAO Jinglin ¹ , LIN Hao ¹ ,  PAN Zequn ¹

1. Medical Affairs Department, Shantou Central Hospital, Shantou, Guangdong 515041, P. R. China;
2. Operations Management Office, Shantou Central Hospital, Shantou, Guangdong 515041, P. R. China;

Corresponding?author：

PAN Zequn, Email: 934797687@qq.com

Keywords：

Day surgery; refined management; medical quality; performance assessment; workflow

DOI：

10.7507/1002-0179.202403109

Video：

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Objective To evaluate the refined management effect of diagnosis related groups (DRG), summarize the experience of refined management, and put forward corrective measures for existing problems. Methods Patients who underwent day surgery services at Shantou Central Hospital between April 2021 and March 2023 were selected. According to the management mode, patients will be divided into a conventional management group (April 2021 to March 2022) and a refined management group (April 2022 to March 2023). The general condition, medical quality, and patient satisfaction indicators of two groups of patients were compared. And according to the DRG group stratification, the differences in medical indexes such as length of hospital stay, total hospitalization expenses, and postoperative complications between the two groups were analyzed. Results A total of 4 584 patients were included, including 1 686 in the conventional management group and 2 898 in the refined management group. There were statistically significant differences between the two groups in terms of patient source, surgical grade, and provincial weight coefficient (P<0.05). However, there was no statistically significant difference in gender, age, and discharge method (P>0.05). The satisfaction of the refined management group with surgical procedures, preoperative guidance, service attitude, and nursing skills was higher than that of the conventional management group (P<0.05). A total of 4 DRG groups (≥ 100 patients) were included, with 2 215 patients in the refined management group and 1 460 patients in the conventional management group. Among them, there were 1496 cases in the group CB39 (cataract surgery), 336 cases in the group GE10 (inguinal and abdominal hernia surgery, age<17 years old), 1412 cases in the group JB29 (partial mastectomy for non-malignant breast tumors), and 431 cases in the group NE19 (vulvar, vaginal, and cervical surgeries). Among them, in the group CB39 (cataract surgery), group GE10 (inguinal and abdominal hernia surgery, age<17 years old), group JB29 (partial mastectomy for non-malignant breast tumors), and group NE19 (vulvar, vaginal, and cervical surgeries), the total hospitalization cost and length of stay in the refined management group were lower than those in the conventional management group (P<0.05). In the group CB39 (cataract surgery) and group NE19 (vulvar, vaginal, and cervical surgeries), the incidence of postoperative complications in the refined management group was lower than that in the conventional management group (P<0.05). In the group GE10 (inguinal and abdominal hernia surgery, age<17 years), the incidence of pain and incision bleeding in the refined management group was lower than that in the conventional management group (P<0.05); In the group JB29 (partial mastectomy for non-malignant breast tumors), the incidence of incision infection in the refined management group was lower than that in the conventional management group (P<0.05). There was no statistically significant difference in other indicators between the two groups (P>0.05). Conclusion Carrying out refined management for day surgery can reduce medical expenses, shorten the length of hospital stay, improve medical quality, and promote the high-quality development of hospitals while ensuring medical safety.

Citation： WANG Dan, XIE Ping, ZHENG Chufa, LI Lixuan, HONG Chunyan, YAO Jinglin, LIN Hao, PAN Zequn. Application effect of refined management in day surgery based on diagnosis-related groups. West China Medical Journal, 2024, 39(12): 1867-1873. doi: 10.7507/1002-0179.202403109 Copy

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10.	劉翔宇, 諶永毅, 周鈺娟, 等. 住院患者護理服務滿意度評價指標體系的構建. 中華護理雜志, 2015, 50(1): 18-21.
11.	田小蕓, 遲放魯, 袁雅生, 等. 某專科醫院基于國標版疾病診斷相關分組的分組效果評價. 中國衛生資源, 2018, 21(5): 411-413.
12.	徐莉, 陳瑩, 倪如暘. 基于疾病診斷相關分組的日間手術實踐效果分析. 華西醫學, 2023, 38(8): 1219-1224.
13.	林旻敏. 公立醫院績效考核對住院病案首頁數據質量的影響. 中國衛生標準管理, 2024, 15(4): 14-17.
14.	毛文平, 駱金鎧, 王力華, 等. 智能交互出院隨訪平臺的構建與應用研究. 中華護理雜志, 2024, 59(15): 1812-1817.
15.	劉炳鑠. 信息化新形勢下醫院管理模式的發展變革. 黑龍江科學, 2020, 11(8): 74-75.
16.	王明剛, 郭姝辰, 陳燚, 等. 疾病診斷相關分組實施對醫用耗材供應管理的影響及對策研究. 中國醫學裝備, 2021, 18(12): 116-119.
17.	劉勤東, 劉銀, 李燕燕, 等. 處方前置審核系統在質子泵抑制劑用藥管理中的應用效果. 中華全科醫學, 2024, 22(10): 1787-1790, 1799.

1. 于麗華. 中國日間手術發展的歷程與展望. 中國醫院管理, 2016, 36(6): 16-18.
2. 傅喆暾, 朱衛紅, 孫如意, 等. 社區聯動下以白內障-日間手術為切入點“分級診療-日間手術”模式的實踐與思考. 中國醫藥指南, 2019, 17(27): 395-397.
3. 趙寧志, 曾宏逵, 高茗, 等. 精細化管理在醫院管理中的應用. 解放軍醫院管理雜志, 2010, 17(5): 423-424.
4. 劉娟, 王志粉, 盧新翠, 等. 構建精細化運營質量管理模式. 中國衛生質量管理. 2020, 27(2): 1-3, 25.
5. 馬洪升, 李大江. 日間手術管理規范. 成都: 四川科學技術出版社, 2021.
6. 鄭雪, 陳平, 鄧清華, 等. 我國基于疾病診斷相關分組的醫療服務績效綜合評價方法的系統評價. 華西醫學, 2019, 34(12): 1384-1385.
7. 張肖肖, 王力紅, 仇葉龍, 等. 基于 DRGs 平臺的臨床醫師團隊醫療質量評價研究. 中國醫院, 2017, 21(1): 31-33.
8. 張瑞迪. 公立醫院實施病例組合指數績效評價的應用探討. 中國醫院管理, 2016, 36(3): 43-45.
9. 邱小丹, 黃曉紅, 王樂潔. 精益管理優化日間手術流程與改善醫療服務的研究. 醫院管理論壇, 2022, 39(8): 48-51, 64.
10. 劉翔宇, 諶永毅, 周鈺娟, 等. 住院患者護理服務滿意度評價指標體系的構建. 中華護理雜志, 2015, 50(1): 18-21.
11. 田小蕓, 遲放魯, 袁雅生, 等. 某專科醫院基于國標版疾病診斷相關分組的分組效果評價. 中國衛生資源, 2018, 21(5): 411-413.
12. 徐莉, 陳瑩, 倪如暘. 基于疾病診斷相關分組的日間手術實踐效果分析. 華西醫學, 2023, 38(8): 1219-1224.
13. 林旻敏. 公立醫院績效考核對住院病案首頁數據質量的影響. 中國衛生標準管理, 2024, 15(4): 14-17.
14. 毛文平, 駱金鎧, 王力華, 等. 智能交互出院隨訪平臺的構建與應用研究. 中華護理雜志, 2024, 59(15): 1812-1817.
15. 劉炳鑠. 信息化新形勢下醫院管理模式的發展變革. 黑龍江科學, 2020, 11(8): 74-75.
16. 王明剛, 郭姝辰, 陳燚, 等. 疾病診斷相關分組實施對醫用耗材供應管理的影響及對策研究. 中國醫學裝備, 2021, 18(12): 116-119.
17. 劉勤東, 劉銀, 李燕燕, 等. 處方前置審核系統在質子泵抑制劑用藥管理中的應用效果. 中華全科醫學, 2024, 22(10): 1787-1790, 1799.

West China Medical Journal

Application effect of refined management in day surgery based on diagnosis-related groups

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