医院管理

广州中医优势病种分值付费政策实施效果探析

Analysis on the effect of dominant diseases of traditional Chinese medicine under the DIP payment mode in Guangzhou

:849-854
 
       目的   分析广州市中医优势病种按病种分值付费政策实施效果,以期为完善广州市中医病种付费方式改革提供参考思路。方法   以广州市某三甲中医医院住院患者在政策实施前(n=6 057)及实施后(n=7 208)住院病历为研究样本,对医院次均住院医疗费用、中医综合治疗费占比、平均住院日进行两独立样本非参数检验等描述性统计分析。  政策实施后,住院人次增长19%,患者次均住院医疗费用下降7.02%(P<0.001),中医综合治疗费用占比提升0.8%P>0.05),医疗机构平均住院日缩短0.63 d(P<0.001),入组中医优势病种患者自费率较非入组的低,医疗机构总体病例组合指数下降,中医优势病种结算有盈余。结论  中医优势病种按病种分值付费政策有利于医保-患者-医院三方共赢;但中医优势病种入组率有待提高,建议加大对中医医疗机构的支持与助力;中医综合治疗费用占比提升不显著,建议完善中医治疗项目医疗服务价格动态调整机制;中医优势病种仅局限在住院,建议实现诊疗单元全覆盖。
       Objective  To discuss the correlation analysis of the hospitalization expenses of TCM dominant diseases under the DIP payment mode,and provide a reference for further promoting the reform of the payment mode of TCM dominant diseases in Guangzhou.Methods  The nonparametric test was used to analyze the number of inpatients,the average hospitalization cost,and the proportion of TCM comprehensive treatment on the data of inpatient records before and after the implementation of the TCM dominant diseases policy,the sample sizes were 6 057 and 7 028 respectively.Results  After the implementation of the TCM dominant diseases policy,there was a slight fluctuation in the number of inpatients from 6 057 to 7 208,the average hospitalization cost was decreased by 7.02%(P<0.001),the proportion of TCM comprehensive treatment costs had an increase of 0.8%(P0.05),the average length of hospital stay was shorten by 0.63 days(P<0.001),the self-expense  rate of the patients with the TCM dominant diseases of in the group was lower than that of the patients without the group,the total case mix index value of the hospital decreased,but there was a surplus on the group of TCM dominant diseases settlement.Conclusios  The policy is conducive to the tripartite win-win of medical insurance,patients and hospitals.However,the enrollment rate of TCM dominant diseases need to be improved,which is suggested to increase the support for TCM hospitals.The proportion of TCM comprehensive treatment has not increased significantly,so it is suggested to improve the dynamic adjustment mechanism of medical service price of TCM treatment items.The TCM dominant diseases are only limited to hospitalization,and it is recommended to achieve full coverage of diagnosis and treatment units.
医院管理

广东省高水平中医院建设背景下的青年中医人才岗位胜任力现状调查分析

Investigation and analysis of the job competence status of young TCM talents under the background of high level TCM hospital construction in Guangdong Province

:273-281
 
      目的   旨在通过实证了解广东省青年中医人才岗位胜任力现状,探讨青年中医人才岗位胜任力素质特征,为青年中医人才培养提供策略。方法   通过专家咨询制定《青年中医人才岗位胜任力评价框架》并开展问卷调查,采用SPSS 26.0进行数据分析。结果   构建了包含8个一级指标、76个二级指标的《青年中医人才岗位胜任力评价框架》;广东省青年中医人才岗位胜任力自评总分整体处于及格以上水平。女性在职业价值和职业素养、临床技能、交流与沟通技能、管理能力和团队合作、批判性思维与学术科研能力的评分高于男性;不同职称在其他附加维度的评分比较具有统计学差异(P<0.05)。结论   构建的评价框架能够有效评估青年中医人才岗位胜任力;广东省青年中医人才岗位胜任力整体处于及格水平,需重视补强短板;女性青年中医人才岗位胜任力多个维度的得分优于男性,着重提升各人群的弱项维度岗位胜任力;进一步建立健全职称评聘制度,以破五唯为导向构建符合不同级别职称的青年中医人才评价机制。
      Objective  To understand the current job competence status of young TCM talents in Guangdong Province through empirical research,to explore the characteristics of job competence and quality of young TCM talents,providing strategy for cultivating young talents in TCM.Methods The “Competency Evaluation Framework for Young TCM Talents” was developed through expert consultation and a questionnaire survey was conducted.SPSS 26.0 was used for data analysis.Results  “Job Competency Evaluation Framework for Young TCM Talents” was constructed,which included 8 primary indicator items and 76 secondary indicator items.The overall self-evaluation score of the overall job competence of young TCM talents in this study was above the passing level.Female score was higher than male in terms of professional value and professional ethics,clinical skills,communication and interpersonal skills,management ability and teamwork,critical thinking and academic research ability.There were statistically significant differences in the scores of different job titles in other additional dimensions(P<0.05).Conclusions  The constructed evaluation framework can effectively assess the job competence of young TCM talents.The overall competence of young TCM talents in Guangdong Province is at a passing level,and attention  should paid to  strengthening their weaknesses.Female young TCM talents have better multidimensional scores in job competence than males,and efforts should be made to focus on improving the weak dimensional job competence of various groups of people.The professional title evaluation and appointment system needs to be established and improved.A talent evaluation mechanism should be built for young TCM talents that meets different levels of professional titles,guided by the principle of breaking the five criteria.
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