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Article(id=1324077976421282334, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202508140, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1754668800000, receivedDateStr=2025-08-09, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614389757, onlineDateStr=2026-11-02, pubDate=1771948800000, pubDateStr=2026-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614389757, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614389757, creator=13701087609, updateTime=1793614389757, updator=13701087609, issue=Issue{id=1324077868950631142, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='4', pageStart='577', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='1771948800000', pubDateStr='2026-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614364134, creator='13701087609', updateTime=1793614446224, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078213328142371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078213332336676, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=682, endPage=687, ext={EN=ArticleExt(id=1324077976614220319, articleId=1324077976421282334, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Assessing the effect of DRG payment reform on service quality in China’s tertiary public hospitals, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the effect of the DRG payment reform on the quality of healthcare services in a Grade A Tertiary Public Hospital in Xinjiang.

Methods

Data were extracted from the inpatient records front pages of basic medical insurance patients admitted to a tertiary Grade A public hospital in Xinjiang between 2020 and 2024. An Interrupted Time Series (ITS) analysis was employed to examine trends in key indicators pre- and post-DRG policy implementation. Indicators spanned three dimensions: in-hospital death (total in-hospital mortality, in-hospital mortality rate of surgical patients, and in-hospital mortality rate of patients with low-risk ICD diseases), patient return (30-day readmission rate), and patient safety (complication rate of surgical patients). The average hospitalization cost and average length of stay were also analyzed to comprehensively evaluate the impact of the DRG policy on the quality of medical services.

Results

No significant trend changes occurred in overall inpatient mortality (β1+β3=-0.000 94, P>0.05), surgical patient mortality (β1+β3=-0.000 07, P > 0.05), 30-day readmission rate (β1+β3=-0.000 13, P>0.05), and surgical complication rates (β1+β3=0.000 07, P>0.05) post-DRG policy implementation. The mortality rate of low-risk ICD diseases (β1+β3=-0.000 03, P<0.05) decreased significantly. After the implementation of the DRG policy, the average length of stay continued to decrease by 0.05 days per month, and the average hospitalization cost continued to decrease by 84.38 yuan per month.

Conclusion

DRG reform has no significant impact on the overall medical quality of the sample hospitals but has a positive effect on reducing the mortality rate of low-risk patients. The DRG policy also has a significant effect on cost control.

, authors=Xuan ZHOU1, Xiao-ju LI2, Li-wen ZHANG3, Yuan-jun PENG1, Bin WEI3, authorsList=Xuan ZHOU, Xiao-ju LI, Li-wen ZHANG, Yuan-jun PENG, Bin WEI, authorCompany=null, correspAuthors=Bin WEI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077977205617186, articleId=1324077976421282334, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=DRG支付方式改革对三级公立医院医疗服务质量的影响分析, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

探讨DRG支付方式改革对新疆某三级甲等公立医院医疗服务质量的影响。

方法

选取2020—2024年新疆某三级甲等公立医院基本医疗保险参保患者住院病案首页数据，采用中断时间序列方法，从住院死亡（住院总死亡率、手术患者住院死亡率、ICD低风险病种患者住院死亡率）、患者重返（30天再入院率）、患者安全（手术患者并发症发生率）三个维度分析DRG政策实施前后各项指标的变化趋势，并结合平均住院日、次均住院费用指标综合评价DRG政策对医疗服务质量的影响。

结果

新疆某三甲医院住院患者住院总死亡率（β1+β3=-0.000 94，P>0.05）、手术患者住院死亡率（β1+β3=-0.000 07，P>0.05）、30天再入院率（β1+β3=-0.000 13，P>0.05）及手术患者并发症发生率（β1+β3=0.000 07，P>0.05）在DRG政策实施后无显著变化趋势；ICD低风险病种死亡率（β1+β3=-0.000 03，P<0.05）显著下降；DRG政策实施后平均住院日每月持续降低0.05天，次均住院费用每月持续降低84.38元。

结论

DRG改革对样本医院整体医疗质量未产生显著影响，对降低低风险患者死亡率存在一定积极作用，DRG政策控费效果显著。

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周璇（1998—），女，硕士在读，研究方向：卫生经济与卫生政策

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魏斌，E-mail:
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周璇（1998—），女，硕士在读，研究方向：卫生经济与卫生政策

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周璇（1998—），女，硕士在读，研究方向：卫生经济与卫生政策

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Evaluation indicators for medical service quality

, figureFileSmall=null, figureFileBig=null, tableContent=
医疗质量指标定义
住院总死亡率住院患者死亡人数占出院人数的比例
手术患者住院死亡率手术患者死亡人数占手术出院人数的比例
ICD低风险病种患者住院死亡率ICD低风险病种患者死亡人数占ICD低风险病种出院人数的比例
30天再入院率出院后30天内再住院患者人数占出院人数比例
手术患者并发症发生率出院诊断符合“手术并发症诊断相关名称”且入院病情为“无”的患者人数占手术患者出院人数的比例
), ArticleFig(id=1324077980296819278, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077976421282334, language=CN, label=表1, caption=

医疗服务质量评价指标

, figureFileSmall=null, figureFileBig=null, tableContent=
医疗质量指标定义
住院总死亡率住院患者死亡人数占出院人数的比例
手术患者住院死亡率手术患者死亡人数占手术出院人数的比例
ICD低风险病种患者住院死亡率ICD低风险病种患者死亡人数占ICD低风险病种出院人数的比例
30天再入院率出院后30天内再住院患者人数占出院人数比例
手术患者并发症发生率出院诊断符合“手术并发症诊断相关名称”且入院病情为“无”的患者人数占手术患者出院人数的比例
), ArticleFig(id=1324077980435231311, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077976421282334, language=EN, label=Table 2, caption=

Descriptive statistical results of medical service quality indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
类别DRG实施前
（n=84 397）		DRG实施后
（n=92 279）		Z/χ2P
住院总死亡率（%）1.361.5916.015<0.001
手术患者住院死亡率（%）0.780.720.0000.991
ICD低风险病种患者住院死亡率（%）0.080.038.6660.003
手术患者并发症发生率（%）1.882.2416.746<0.001
30天再入院率（%）9.969.2724.200<0.001
平均住院日（d）8.88±5.737.84±4.88-45.705<0.001
次均住院费用（元）13 450.30±20 852.4610 928.61±17 608.63-53.225<0.001
), ArticleFig(id=1324077980506534480, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077976421282334, language=CN, label=表2, caption=

医疗服务质量指标描述性统计结果

, figureFileSmall=null, figureFileBig=null, tableContent=
类别DRG实施前
（n=84 397）		DRG实施后
（n=92 279）		Z/χ2P
住院总死亡率（%）1.361.5916.015<0.001
手术患者住院死亡率（%）0.780.720.0000.991
ICD低风险病种患者住院死亡率（%）0.080.038.6660.003
手术患者并发症发生率（%）1.882.2416.746<0.001
30天再入院率（%）9.969.2724.200<0.001
平均住院日（d）8.88±5.737.84±4.88-45.705<0.001
次均住院费用（元）13 450.30±20 852.4610 928.61±17 608.63-53.225<0.001
), ArticleFig(id=1324077980586226257, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077976421282334, language=EN, label=Table 3, caption=

ITS regression parameters of the impact of DRG on medical quality

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类别β0Pβ1Pβ2Pβ3Pβ1+β3P
住院总死亡率0.019 10<0.001-0.000 260.2460.016 870.140-0.000 680.336-0.000 940.161
手术患者住院死亡率0.013 21<0.001-0.000 300.0940.004 280.1640.000 230.321-0.000 070.642
ICD低风险病种患者住院死亡率0.001 310.001-0.000 030.1170.000 240.4080.000 000.944-0.000 030.001
手术患者并发症发生率0.020 93<0.001-0.000 050.8280.002 320.5200.000 120.6530.000 070.608
30天再入院率0.111 09<0.001-0.000 380.639-0.005 260.6060.000 250.775-0.000 130.694
平均住院日9.93<0.001-0.070.0000.590.0260.020.393-0.05<0.001
次均住院费用15 153.34<0.001-88.140.019-517.360.4603.770.940-84.380.010
), ArticleFig(id=1324077980686889554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077976421282334, language=CN, label=表3, caption=

DRG对医疗质量影响的ITS回归参数

, figureFileSmall=null, figureFileBig=null, tableContent=
类别β0Pβ1Pβ2Pβ3Pβ1+β3P
住院总死亡率0.019 10<0.001-0.000 260.2460.016 870.140-0.000 680.336-0.000 940.161
手术患者住院死亡率0.013 21<0.001-0.000 300.0940.004 280.1640.000 230.321-0.000 070.642
ICD低风险病种患者住院死亡率0.001 310.001-0.000 030.1170.000 240.4080.000 000.944-0.000 030.001
手术患者并发症发生率0.020 93<0.001-0.000 050.8280.002 320.5200.000 120.6530.000 070.608
30天再入院率0.111 09<0.001-0.000 380.639-0.005 260.6060.000 250.775-0.000 130.694
平均住院日9.93<0.001-0.070.0000.590.0260.020.393-0.05<0.001
次均住院费用15 153.34<0.001-88.140.019-517.360.4603.770.940-84.380.010
), ArticleFig(id=1324077980758192723, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077976421282334, language=EN, label=Table 4, caption=

ITS regression parameters of the impact of DRG on medical quality

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结果变量β0Pβ1Pβ2Pβ3Pβ1+β3P
滞后3个月
住院总死亡率0.016 56<0.0010.000 250.9690.019 840.045-0.001 260.019-0.001 270.008
手术患者住院死亡率0.012 71<0.001-0.000 250.0970.006 730.0180.000 040.847-0.000 210.097
ICD低风险病种患者住院死亡率0.000 730.2240.000 030.588-0.000 160.899-0.000 100.098-0.000 070.027
手术患者并发症发生率0.019 45<0.0010.000 100.6560.000 690.869-0.000 120.651-0.000 020.879
30天再入院率0.104 07<0.0010.000 310.7130.004 870.808-0.001 800.124-0.001 490.067
平均住院日9.78<0.001-0.050.0001.220.004-0.030.251-0.09<0.001
次均住院费用14 812.79<0.001-55.010.111512.270.609-104.790.175-159.800.006
滞后6个月
住院总死亡率0.013 160.0060.000 300.2890.005 840.611-0.001 400.088-0.001 100.125
手术患者住院死亡率0.011 21<0.001-0.000 110.4300.001 420.6740.000 040.874-0.000 080.649
ICD低风险病种患者住院死亡率0.000 610.2230.000 040.312-0.001 350.152-0.000 070.088-0.000 030.004
手术患者并发症发生率0.018 95<0.0010.000 140.435-0.002 440.516-0.000 050.8170.000 090.571
30天再入院率0.098 370.0000.000 840.262-0.036 110.015-0.000 850.303-0.000 010.982
平均住院日9.520.000-0.030.1810.080.890-0.030.293-0.060.000
次均住院费用14 487.110.000-24.670.505-1 696.130.126-59.420.284-84.090.046
), ArticleFig(id=1324077980846273108, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077976421282334, language=CN, label=表4, caption=

DRG对医疗质量影响的ITS回归参数

, figureFileSmall=null, figureFileBig=null, tableContent=
结果变量β0Pβ1Pβ2Pβ3Pβ1+β3P
滞后3个月
住院总死亡率0.016 56<0.0010.000 250.9690.019 840.045-0.001 260.019-0.001 270.008
手术患者住院死亡率0.012 71<0.001-0.000 250.0970.006 730.0180.000 040.847-0.000 210.097
ICD低风险病种患者住院死亡率0.000 730.2240.000 030.588-0.000 160.899-0.000 100.098-0.000 070.027
手术患者并发症发生率0.019 45<0.0010.000 100.6560.000 690.869-0.000 120.651-0.000 020.879
30天再入院率0.104 07<0.0010.000 310.7130.004 870.808-0.001 800.124-0.001 490.067
平均住院日9.78<0.001-0.050.0001.220.004-0.030.251-0.09<0.001
次均住院费用14 812.79<0.001-55.010.111512.270.609-104.790.175-159.800.006
滞后6个月
住院总死亡率0.013 160.0060.000 300.2890.005 840.611-0.001 400.088-0.001 100.125
手术患者住院死亡率0.011 21<0.001-0.000 110.4300.001 420.6740.000 040.874-0.000 080.649
ICD低风险病种患者住院死亡率0.000 610.2230.000 040.312-0.001 350.152-0.000 070.088-0.000 030.004
手术患者并发症发生率0.018 95<0.0010.000 140.435-0.002 440.516-0.000 050.8170.000 090.571
30天再入院率0.098 370.0000.000 840.262-0.036 110.015-0.000 850.303-0.000 010.982
平均住院日9.520.000-0.030.1810.080.890-0.030.293-0.060.000
次均住院费用14 487.110.000-24.670.505-1 696.130.126-59.420.284-84.090.046
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DRG支付方式改革对三级公立医院医疗服务质量的影响分析
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周璇 1 , 李小菊 2 , 张粝文 3 , 彭元骏 1 , 魏斌 3
现代预防医学 | 卫生政策与管理 2026,53(4): 682-687
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现代预防医学 |卫生政策与管理 2026 , 53 (4) : 682 -687
DRG支付方式改革对三级公立医院医疗服务质量的影响分析
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周璇1, 李小菊2, 张粝文3, 彭元骏1, 魏斌3
作者信息
  • 1.石河子大学医学院预防医学系，新疆 石河子 832000
  • 2.新疆生产建设兵团重要新发传染病防控与公共卫生安全重点实验室
  • 3.石河子大学第一附属医院
通讯作者:
魏斌，E-mail:
作者简介:

周璇（1998—），女，硕士在读，研究方向：卫生经济与卫生政策

Assessing the effect of DRG payment reform on service quality in China’s tertiary public hospitals
Xuan ZHOU1, Xiao-ju LI2, Li-wen ZHANG3, Yuan-jun PENG1, Bin WEI3
Affiliations
  • Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang 832000, China
出版时间: 2026-02-25 doi: 10.20043/j.cnki.MPM.202508140
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摘要
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目的

探讨DRG支付方式改革对新疆某三级甲等公立医院医疗服务质量的影响。

方法

选取2020—2024年新疆某三级甲等公立医院基本医疗保险参保患者住院病案首页数据，采用中断时间序列方法，从住院死亡（住院总死亡率、手术患者住院死亡率、ICD低风险病种患者住院死亡率）、患者重返（30天再入院率）、患者安全（手术患者并发症发生率）三个维度分析DRG政策实施前后各项指标的变化趋势，并结合平均住院日、次均住院费用指标综合评价DRG政策对医疗服务质量的影响。

结果

新疆某三甲医院住院患者住院总死亡率（β1+β3=-0.000 94，P>0.05）、手术患者住院死亡率（β1+β3=-0.000 07，P>0.05）、30天再入院率（β1+β3=-0.000 13，P>0.05）及手术患者并发症发生率（β1+β3=0.000 07，P>0.05）在DRG政策实施后无显著变化趋势；ICD低风险病种死亡率（β1+β3=-0.000 03，P<0.05）显著下降；DRG政策实施后平均住院日每月持续降低0.05天，次均住院费用每月持续降低84.38元。

结论

DRG改革对样本医院整体医疗质量未产生显著影响，对降低低风险患者死亡率存在一定积极作用，DRG政策控费效果显著。

DRG  /  公立医院  /  医疗质量  /  中断时间序列
Objective

To explore the effect of the DRG payment reform on the quality of healthcare services in a Grade A Tertiary Public Hospital in Xinjiang.

Methods

Data were extracted from the inpatient records front pages of basic medical insurance patients admitted to a tertiary Grade A public hospital in Xinjiang between 2020 and 2024. An Interrupted Time Series (ITS) analysis was employed to examine trends in key indicators pre- and post-DRG policy implementation. Indicators spanned three dimensions: in-hospital death (total in-hospital mortality, in-hospital mortality rate of surgical patients, and in-hospital mortality rate of patients with low-risk ICD diseases), patient return (30-day readmission rate), and patient safety (complication rate of surgical patients). The average hospitalization cost and average length of stay were also analyzed to comprehensively evaluate the impact of the DRG policy on the quality of medical services.

Results

No significant trend changes occurred in overall inpatient mortality (β1+β3=-0.000 94, P>0.05), surgical patient mortality (β1+β3=-0.000 07, P > 0.05), 30-day readmission rate (β1+β3=-0.000 13, P>0.05), and surgical complication rates (β1+β3=0.000 07, P>0.05) post-DRG policy implementation. The mortality rate of low-risk ICD diseases (β1+β3=-0.000 03, P<0.05) decreased significantly. After the implementation of the DRG policy, the average length of stay continued to decrease by 0.05 days per month, and the average hospitalization cost continued to decrease by 84.38 yuan per month.

Conclusion

DRG reform has no significant impact on the overall medical quality of the sample hospitals but has a positive effect on reducing the mortality rate of low-risk patients. The DRG policy also has a significant effect on cost control.

DRG  /  Public hospitals  /  Medical quality  /  Interrupt time series
周璇, 李小菊, 张粝文, 彭元骏, 魏斌. DRG支付方式改革对三级公立医院医疗服务质量的影响分析. 现代预防医学, 2026 , 53 (4) : 682 -687 . DOI: 10.20043/j.cnki.MPM.202508140
Xuan ZHOU, Xiao-ju LI, Li-wen ZHANG, Yuan-jun PENG, Bin WEI. Assessing the effect of DRG payment reform on service quality in China’s tertiary public hospitals[J]. Modern Preventive Medicine, 2026 , 53 (4) : 682 -687 . DOI: 10.20043/j.cnki.MPM.202508140
正文
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依据2019年《国家医疗保障疾病诊断相关分组（CHS-DRG）分组与付费技术规范》，疾病诊断相关分组（Diagnosis Related Groups，DRG）以病案首页主要诊断为基础，先按解剖/生理系统（International Classification of Diseases, Tenth Revision, ICD-10）划分主要诊断大类（Major Diagnostic Category，MDC）大类；再按治疗方式（手术/非手术/操作）结合临床经验细分至核心疾病诊断相关组（Adjacent Diagnosis Related Groups, ADRG）；最终依据合并症、并发症及资源消耗相似性，通过统计分析细化为DRG分组，实质上是一种病例组合分类方案。2011年北京市率先在6家医疗机构启动按疾病诊断相关分组预付费（Diagnosis Related Groups-Prospective Payment System, DRG-PPS）制度试点；截至2017年，试点范围已扩展至8个省份的部分医疗机构；2019年启动DRG付费改革国家级试点，覆盖北京、上海、新疆在内的30个重点城市，样本医院即位于上述试点城市之列。根据国家医疗保障局2021年发布的《DRG/DIP支付方式改革三年行动计划》，我国将于2025年底前全面实施DRG/DIP支付方式，实现医保支付改革全覆盖[1]。在实施DRG支付方式之前，我国医保支付主要实行“按项目付费”，部分学者认为按项目支付可能激励医疗服务机构提供非必要诊疗服务及增加患者就诊频次，进而增加医保基金支出与患者自付费用[1-2]，进而国家医疗保障局开展DRG付费，期望实现医、保、患三方共赢的目标。现有文献显示，DRG政策的实施在降低医疗费用方面成效显著[3-4]，但DRG付费政策对患者住院服务质量的影响，现有研究呈现不一致的结果。部分研究显示，DRG付费政策显著降低了患者的住院总死亡率和再入院率[1]；然而，亦有研究发现，DRG改革后院内死亡率、手术并发症发生率及30天内再入院率并无显著变化[5-6]；此外，还有研究指出，DRG政策实施后患者术后并发症发生率以及病死率呈现上升趋势[6-7]。本研究立足于医院维度，实证分析DRG支付制度改革对患者医疗质量的影响，探究控制住院费用条件下维持及提升医疗服务质量的策略。
本研究聚焦于新疆维吾尔自治区某三级甲等公立医院，该医院作为区域性医疗中心，积极响应国家深化医疗保障制度改革的政策导向，于2022年7月正式启动按疾病诊断相关分组（DRG）支付方式的实际付费改革试点。截至研究开展之际，该项改革已实施逾两年，渡过了初期的政策适应与系统调试阶段，进入了相对稳定的运行期。在此背景下，系统探究DRG支付方式对该院住院患者医疗质量产生的具体影响，具有重要的理论价值与现实意义。
1　资料与方法
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1.1　资料来源
本研究分析数据源自新疆某三级甲等公立医院住院病案首页数据，主要包括患者一般人口学信息以及疾病诊断、住院费用、医疗付款方式、住院天数等诊疗信息。纳入标准：2020—2024年该院基本医疗保险参保患者；排除标准：（1）住院天数小于1天或者大于60天，（2）住院费用小于100元；此外，2022年8月—2022年12月的数据因疫情原因，就医人数不足历史平均水平的1/3，容易对研究结果产生偏差，故不纳入分析。最终纳入住院患者176 676人。
1.2　研究方法
首先对于医疗质量指标进行描述性分析，计数资料采用χ2检验，平均住院日及次均住院费用数据呈偏态分布，采用Mann-Whitney检验。其次，采用中断时间序列设计（Interrupted Time Series, ITS），量化评估DRG政策实施前后医疗质量核心指标的变化趋势，探讨DRG政策对样本医院医疗质量影响，进而综合评价医院的医疗质量管理情况。ITS回归模型为：Yt=β0+β1X1+β2X2+β3X3+ε[8]，X1为时间序列，即研究期间的月份序列编码，2020年1月—2024年12月依次赋值1到55。X2为干预阶段虚拟变量，干预前（2020年1月—2022年6月）赋值为“0”，干预后（2022年7月—2024年12月）赋值为“1”；X3为干预后时间累积变量，干预前的观察点定义为“0”，干预后（2022年7月—2024年12月）依次赋值1~25；ε是误差项。β0为常数项；β1为DRG政策实施前的斜率；β2为DRG政策实施时的即刻水平改变量；β3为DRG政策实施前后斜率之差；实施后指标的变化趋势为β1+β3。本研究采用Cumby-Huizinga验证数据以解决模型中存在的自相关问题[9]。
1.3　指标选取
世界卫生组织（World Health Organization, WHO）等权威机构认证的国际医疗质量评价的核心指标体系聚焦三大维度：住院结局指标、非计划性再入院指标、医疗安全过程指标[10]。《三级医院评审标准（2022年版）》及《三级医院评审标准（2025年版）》将患者住院总死亡率、新生儿患者住院死亡率、手术患者住院死亡率、ICD低风险病种患者住院死亡率、手术患者术后48小时/31天内非预期重返手术室再次手术率、住院患者出院后0~31天非预期再住院率指标作为医疗质量考核指标[1]。三级公立医院绩效考核指标（2024年版）及国家三级公立医院绩效监测操作手册（2025版）中手术患者并发症发生率（《三级医院评审标准》2022年版中并发于手术或手术后的疾病或情况，包括：手术后肺栓塞、深静脉血栓、脓毒症、出血或血肿、伤口裂开、猝死、呼吸衰竭、生理/代谢紊乱、与手术/操作相关感染、手术过程中异物遗留、手术患者麻醉并发症、肺部感染与肺机能不全、手术意外穿刺伤或撕裂伤、手术后急性肾衰竭等。）、I类切口手术部位感染率、低风险组病例死亡率（《三级医院评审标准》2022年版中所列的“115个ICD低风险病种”）3个关键指标被纳入医疗服务结果维度的评价体系[11-12]。国家医疗保障局在《国家医疗保障疾病诊断相关分组（CHS-DRG）分组与付费技术规范》中建议使用入出院诊断符合率、30天内返往率、院内感染发生率和平均住院日等指标考核医疗质量，避免并遏制医院可能出现的选择病人、升级诊断和服务不足等现象。本研究通过整合国际和国内医疗服务质量评价指标及数据的可获得性，结合国家医保局对DRG改革中医疗服务质量监控重点，选择住院总死亡率、手术患者住院死亡率、ICD低风险病种患者住院死亡率、手术患者并发症发生率、30天再入院率5个指标，从住院死亡、重返以及患者安全三个维度评价医疗质量。此外，本研究还纳入除了直接反映医疗服务结果指标外的平均住院日、次均住院费用2个指标以更好地反映医疗服务质量变化。指标名称及对应定义见表1。
2　结果
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2.1　住院患者基本情况
DRG政策实施前住院患者84 397例，占比47.77%；DRG政策实施后住院患者92 279例，占比52.23%。DRG政策实施前住院患者死亡人数为1 150例，DRG政策实施后1 470例。DRG政策实施前手术患者住院死亡人数169例，DRG政策实施后185例。DRG政策实施前ICD低风险病种患者29例，DRG政策实施后减少至12例。DRG政策实施前手术患者并发症发生人数407例，DRG政策实施后579例。DRG政策实施前30天再入院人数8 404例，DRG政策实施后8 552例。DRG政策实施后的平均住院日由8.88天降至7.84天，而次均住院费用则由13 450.30元降至10 928.61元。卡方检验结果显示，住院死亡类指标方面，ICD低风险病种患者住院死亡率呈递减趋势，且差异具有统计学意义；手术患者住院死亡率在DRG政策实施前后差异不具有统计学意义，住院总死亡率呈上升趋势，差异具有统计学意义。患者30天再入院率、平均住院日、次均住院费用3个指标在DRG政策实施后均呈下降趋势，且差异具有统计学意义。但手术患者并发症发生率在DRG政策实施后呈上升趋势，且差异有统计学意义。见表2。
2.2　中断时间序列分析结果
中断时间序列结果显示，对于住院死亡类指标，DRG政策实施后住院总死亡率（β1+β3=-0.000 94，P>0.05）和手术患者住院死亡率（β1+β3=-0.000 07，P>0.05）与政策实施前相比没有明显差异。DRG政策实施后ICD低风险病种患者住院死亡率（β1+β3=-0.000 03，P<0.05）下降趋势显著。对于重返类指标，DRG政策实施后30天再入院率（β1+β3=-0.000 13，P>0.05）与DRG改革前比无显著差异。对于患者安全类指标，结果显示DRG政策实施后手术患者并发症发生率（β1+β3=0.000 07，P>0.05）与DRG改革前比也无显著差异。
对于与医疗质量相关联的指标，结果显示DRG政策带来的效应是使平均住院日每月降低0.05天（P<0.05）及使次均住院费用每月降低84.38元（P<0.05），且下降趋势均显著。见表3及图1。
2.3　敏感性分析
临床实践在DRG支付方式下的转型是一个渐进过程，其政策效果的充分显现可能存在延迟。为确保研究结论的可靠性，我们通过滞后分析，将DRG政策实施的干预点分别设置为滞后3个月（2022年10月）和滞后6个月（2023年1月），并基于此重新构建中断时间序列模型，对所有核心医疗质量指标及效率费用指标进行了再次估计，结果显示除住院总死亡率指标在DRG政策滞后3个月模型中呈现显著下降趋势（P=0.008），在6个月滞后模型中变得不显著（P=0.125）外，其余指标与主分析一致，证实了本研究主要结论的高度稳健性，见表4。
3　讨论
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3.1　DRG付费改革对研究医院住院患者的整体医疗质量无显著影响
本研究显示DRG政策实施后住院总死亡率由1.36%上升至1.59%，但中断时间序列结果显示DRG政策实施后的患者住院总死亡率差异没有统计学意义，结合中断时间序列回归模型结果图发现，疫情结束后短期1月内住院患者总死亡率增长显著，这一现象可能归因于疫情高峰过后医疗系统面临的短期冲击，但DRG政策实施后长期趋势不显著，说明在DRG政策长期稳定运行阶段，研究医院的住院患者总死亡率未发生显著变化。ICD低风险病种患者住院死亡率由DRG改革前的0.08%降至DRG改革后0.03%，卡方检验显示ICD低风险病种死亡率呈显著下降趋势，中断时间序列显示DRG政策实施前ICD低风险病种患者住院死亡率呈下降趋势，而DRG政策实施后整体也呈显著下降趋势，结合低风险死亡病例数来看，该院低风险死亡的患者已维持在一个较低的水平，且DRG政策对于降低低风险患者的死亡存在一定的积极影响，有利于轻症患者医疗质量安全的提升。医保患者手术并发症发生率在DRG政策实施后上升，经卡方检验有统计学意义，郭佳瑜[6]研究也发现DRG政策实施后，医保与自费患者术后并发症发生率呈显著上升趋势，认为可能与病案首页数据质量提升导致的记录规范化相关，但本研究中断时间序列模型结果未发现DRG政策实施后并发症发生率的显著上升趋势，说明DRG政策的长期效果并未使医保患者术后并发症显著升高。此外，本研究中手术患者住院死亡率、30天再入院率在DRG政策实施后均无显著的统计学意义，说明DRG政策的实施对于该院整体的医疗质量并未带来太大的变化。以往对DRG付费改革对住院服务质量评估研究中，院内死亡率多数无显著变化[5,13]，少数呈显著下降[14]；30天内再入院率多数为上升或不变[5,15-16]，此外，多数研究并未发现DRG付费改革对手术并发症发生率造成影响[5,13,17]。本研究的结果与既往多数研究的结果较为一致，此外，本研究还发现DRG政策对于轻症患者医疗安全存在一定积极影响。
3.2　DRG付费改革控费效果明显
DRG政策实施后患者平均住院日与次均住院费用呈下降趋势，体现了DRG优化资源配置的作用，这与叶娟[3]、闫彬[4]等人的研究结果一致。国家医保局推行DRG付费方式，主要期望达成以下三方面目标：其一，医保局聚焦控费提效，遏制医疗费用过快增长，保障医保基金可持续；其二，医院转向精益运营，以成本管控和诊疗行为规范驱动服务升级；其三，患者获得可预期的高性价比服务。控费是增效的基础，控制不合理费用支出，本身就是释放资源、提高资源利用效率的过程；增效强化控费，提高效率（如缩短住院日、加快床位周转）直接降低了单位病例的固定成本分摊（如床位费、管理费），进一步巩固了控费效果。但DRG付费并非单纯追求低价和快速，其评价体系包含质量安全指标，即低风险病种死亡率、手术并发症发生率、30天再入院率等，成功的DRG实施是在保障基本医疗质量和安全的前提下，追求成本和效率的最优化，本研究从质量、费用和效率三个维度综合探讨了新疆某三甲医院实行DRG后的变化趋势，该院在保证医疗质量不降低的情况下显著降低了住院费用和住院天数，初步达到了DRG政策所期望的目标，未来还可进一步优化医院管理方案，在现有水平的基础上实现DRG支付方式下公立医院的高质量发展。
本研究发现DRG付费改革在研究医院实现了次均住院费用和平均住院日的显著下降，而整体医疗质量未发生显著下降，这与国家医保局“控费提效、保障质量”的政策预期基本一致。尤其值得注意的是，ICD低风险病种死亡率的下降表明DRG改革对轻症患者医疗安全具有积极影响。未来，DRG支付方式可作为医院精益管理的有效工具，医院应在DRG框架下探索病种精细化管理和绩效激励，同时需配套强化质量监测。本研究的局限性在于仅选取新疆地区一家三级甲等医院作为样本，其结果的代表性和普适性需谨慎对待。不同地区、不同级别医院的DRG实施效果可能存在差异。然而，本研究通过严谨的中断时间序列设计，提供了DRG改革对医疗质量影响的实证证据，为后续多中心研究奠定了基础。未来研究可进一步拓展至更多样本医院，并结合地区经济水平、医院规模等因素进行分层分析。
基金
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  • 石河子大学第一附属医院管理基金项目(GL202204)
文献
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2026年第53卷第4期
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文章信息
doi: 10.20043/j.cnki.MPM.202508140
  • 接收时间：2025-08-09
  • 首发时间：2026-11-02
  • 出版时间：2026-02-25
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  • 收稿日期：2025-08-09
基金
石河子大学第一附属医院管理基金项目(GL202204)
作者信息
    1.石河子大学医学院预防医学系，新疆 石河子 832000
    2.新疆生产建设兵团重要新发传染病防控与公共卫生安全重点实验室
    3.石河子大学第一附属医院

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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