【摘要】 目的 探究医联体模式下疾病诊断相关分组（DRG）学习对基层全科医师转诊行为的影响作用。方法 以河南省内某三甲医院及其医联体内的某二甲医院为研究对象，通过线上线下结合的方式对二甲医院全科医师进行DRG知识培训。培训结束后利用病案首页提取培训前后各1年的DRG相关数据，通过聚类分析了解这一时间内由该二甲医院全科医学科向上转诊至该三甲医院的所有患者病案首页相对权重（RW）值数据，并比较培训前后DRG组数、费用消耗指数及时间消耗指数、低风险组死亡率变化。结果 DRG培训前的1年中由该科室转诊至三甲医院患者共137人，培训后1年转诊患者81人。通过K-均值聚类法将218人转诊的患者的RW值最终分为4个区间，其聚类中心值分别为0.71、1.33、2.36(F=209.07,P<0.05)。比较DRG培训前后转诊患者在每一区间内的占比，发现培训后0.71<RW值≤1.33区间内转诊患者有所降低，RW值>1.33区间内转诊患者占比较前升高（χ~2分别=10.17、22.80,P均<0.05）,RW值≤0.71区间比例在培训前后无明显差异（χ~2=3.82,P>0.05）。同时，培训后转诊患者的费用消耗指数及时间消耗指数均较培训前有所上升，低风险死亡率无变化。结论 医联体模式下提高全科医师DRG认知水平可对全科医师转诊行为产生积极的影响作用。更多还原

【Abstract】 Objective To explore the effect of DRG learning on the referral behavior of general practitioner under medical alliance model. Methods A tertiary hospital of Henan Province and a secondary hospital within its medical alliance were selected as research aera. All general practitioners in the secondary hospital took part in diagnosis related groups(DRG)training through means of online and offline methods.DRG index data were collected by the first page data 1 year before and after training.The distribution of relative weight(RW)value intervals were analyzed by cluster analysis during this period,DRGs groups,the cost consumption index,the time consumption index and low-risk mortality rate of referred patients from this secondary hospital were compared before and after training as well. Results A total of 137patients were referred to the tertiary hospitals in the 1 year prior to training,and 81 patients were referred in the 1 year after training.The RW values of the 218 referred patients were finally classified into 4 intervals by K-means clustering,and their cluster centers were 0.71,1.33,2.36(F=209.07,P<0.05).Comparing the percentage of referred patients within each interval before and after DRG training,it was found that the percentage of patients referred within the interval of 0.71<RW≤1.33 was lower after training,the percentage of referred patients within the interval of RW>1.33 was higher（χ~2=10.17,22.80,P<0.05）,and there was no statistically significant difference in the percentage of the interval of RW≤0.71 before and after training （χ~2=3.82,P>0.05）.Meanwhile,the cost consumption index and time consumption index of referred patients increased after the training compared with the pre-training period,and there was no change in low-risk mortality. Conclusion Improving the DRG awareness among general practitioners may positively influence the referral behavior of general practitioner under medical alliance model.更多还原