【摘要】 目的:分析CHS-DRG付费改革对上海市乳腺癌患者住院服务质量的影响，为推进医保支付方式改革提供参考。方法:收集上海市16家公立医院2018年1月-2021年7月乳腺癌住院患者病案首页数据，采用双重差分模型分析乳腺癌患者在CHS-DRG付费改革后住院服务质量的变化，并进行异质性分析和稳健性检验。结果:CHS-DRG付费改革后，乳腺癌患者住院天数(β=-0.249,P=0.541)、院内死亡率(β=-0.115,P=0.757)、手术并发症发生率(β=-0.574,P=0.666)、30天内再入院率没有显著变化(β=-1.111,P=0.506)。异质性结果发现，轻症患者30天内再入院率显著下降(β=-4.236,P=0.047)。结论:短期内，上海市CHS-DRG付费改革对乳腺癌患者住院服务质量的影响有限，轻症患者住院服务质量得到改善。相关部门应结合CHS-DRG分组优化乳腺癌临床路径管理，加强医疗信息化系统建设，针对不同特征的患者制定更具针对性的政策措施，并建立长期质量监管机制，关注改革溢出效应，加强质量评估的连续性，以更全面地评价改革效果。更多还原

【Abstract】 Objective: To analyze the impact of the inpatient healthcare quality for breast cancer patients in Shanghai city following the implementation of CHS-DRG payment reform, and to provide reference for promoting the medical insurance payment reform. Methods: Discharge records of hospitalized patients with breast cancer from 16 public hospitals in Shanghai city from January 2018 to July 2021 were collected. The difference in differences model was used to analyze the changes of inpatient healthcare quality for breast cancer patients after CHS-DRG payment reform, and the heterogeneity analysis and robustness test were conducted. Results: After CHS-DRG payment reform, breast cancer patients in length of stay(β=-0.249, P=0.541), in-hospital mortality rate(β=-0.115, P=0.757), the incidence of surgical complications(β=-0.574, P=0.666) and the readmission rate within 30 days were no significant changes(β=-1.111, P=0.506). The heterogeneity result showed a significant decrease in the readmission rate within 30 days among mild patients(β=-4.236, P=0.047). Conclusion: In the short term, the CHS-DRG payment reform in Shanghai has limited impact on the inpatient healthcare quality for breast cancer, and the inpatient healthcare quality for mild patients has been improved. Relevant departments should combine the CHS-DRG group to optimize the clinical pathway management of breast cancer, strengthen the construction of medical information system, formulate more targeted policies and measures for patients with different characteristics, and establish a long-term quality supervision mechanism, pay attention to the spillover effect of reform, and strengthen the continuity of quality assessment to evaluate the effect of reform in a more comprehensive way.更多还原