临床医生视角下中医优势病种支付方式改革现状及可行性研究
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篇名: 临床医生视角下中医优势病种支付方式改革现状及可行性研究
TITLE: Study on the current status and feasibility of payment reform for TCM dominant diseases from the perspective of clinicians
摘要: 目的 从临床医生视角了解中医优势病种支付方式改革现状及可行性,为优化和完善改革实施方案提供参考。方法自行设计问卷,采用简单随机抽样法,在贵州省中医优势病种支付方式改革试点医院抽取临床医生进行面对面的问卷调查。采用SPSS20.0软件对问卷结果进行统计,并对改革可行性的影响因素进行单因素分析和多因素有序Logistic回归分析。结果本次调查共发放问卷420份,收回有效问卷413份,有效率为98.3%。86.0%的临床医生认为本院开展此项改革具有可行性,81.8%认为试点医院遴选出的中医优势病种比较合理。改革后,分别有61.0%、58.8%的临床医生表示所在科室每日诊疗患者数及与患者沟通的意愿均增加;60.3%表示改革中遇到的困难与阻碍是中医疾病复杂多样,患者采用中西医结合治疗,难以用统一的疾病与手术代码进行正确编码;76.3%表示改革实施最大的优点是提高了医疗质量,54.2%表示最大的缺点是医生自主性受到过多限制。多因素有序Logistic回归分析结果显示,改革实施后诊疗服务变化(患者再入院率变化)、中医优势病种遴选的合理性、医疗费用是否降低、医患关系是否改善、是否促进分级诊疗是改革可行性的影响因素(P<0.05)。结论贵州省开展中医优势病种支付方式改革具有一定的可行性,但目前处于探索阶段,影响改革可行性的因素较多。建议今后在全省甚至全国推广时应注意遴选出更多、更合理的优势病种进行付费改革,进一步规范临床医生诊疗行为,控制医疗费用不合理增长,加强与患者沟通,提高中医疾病准确诊断率,对优势病种实施分级测算,促进医疗机构分级诊疗等。
ABSTRACT: OBJECTIVE To understan d the c urrent situation and feasibility of payment reform for TCM dominant diseases from the perspective of clinicians ,so as to provide reference for optimizing and improving the reform scheme. METHODS A questionnaire was designed by ourselves ,and a simple random sampling method was used to select clinicians from the pilot hospitals of payment reform for TCM dominant diseases in Guizhou province to conduct a face-to-face questionnaire survey. SPSS 20.0 software was used for statistical analysis. The single-factor analysis and ordered Logistic regression analysis of multi-factor were used to analyze the influential factors of reform feasibility. RESULTS A total of 420 questionnaires were distributed in this survey,and 413 valid questionnaires were recovered ,with an effective rate of 98.3%. Totally 86.0% of the clinicians thought that it was feasible for the reform to be carried out in their hospitals ,and 81.8% thought that the selected TCM dominant diseases in the pilot hospitals were reasonable. After the reform was carried out ,61.0% and 58.8% of clinicians indicated that the daily number of patients treated in their departments and their willingness to communicate with patients increased ,respectively;60.3% indicated that the difficulties and obstacles encountered in the reform were the complexity and diversity of TCM diseases ,for the treatment of patients with integrated traditional Chinese and Western medicine ,which was difficult to use a unified disease and surgery code to correctly code ;76.3% indicated that the greatest advantage of the reform implementation was the improvement of medical quality ,while 54.2% indicated that the greatest disadvantage was the excessive restriction of doctors ’autonomy. The results of multi-factor ordered Logistic regression analysis showed that changes in treatment services (changes in readmission rate of patient),the reasonableness of the selection of TCM dominant diseases ,and whether to reduce medical costs ,improve doctor-patient relationship , and promote hierarchical treatment were the influential factors of reform feasibility after the implementation of reform (P<0.05). CONCLUSIONS It is feasible to carry out payment reform for TCM dominant diseases in Guizhou province ,but it is still in the exploratery stage ,and there are many factors affecting the feasibility of the reform. It is suggested that in the future ,when promoting in the whole pr ovince and even the whole c ountry,we should pay attention to selecting more and more reasonable dominant diseases for payment reform , further standardize the diagnosis and treatment behavior of clinicians , control the unreasonablegrowth of medical expenses , strengthen communication between clinicians and patients, improve the accurate diagnosis rate of traditional Chinese medicine diseases ,implement hierarchical calculation of dominant diseases ,and promote hierarchical diagnosis and treatment of medical institutions.
期刊: 2022年第33卷第14期
作者: 李祖兰,周戈耀,梅玉虹,毛佳
AUTHORS: LI Zulan,ZHOU Geyao ,MEI Yuhong ,MAO Jia
关键字: 中医优势病种;支付方式改革;可行性;影响因素;临床医生
KEYWORDS: TCM dominant diseases ;payment reform ;feasibility;influential factors ;clinicians
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