administrative MDT medical insurance management quality control indexes p atients’ satisfaction
江苏省医院协会医院管理创新研究基金面上指导课题（JSYGY-3-2018-185）
目的：探讨“行政MDT”管理模式在医院医保管理工作中的运用及效果。方法：比较实施医保“行政MDT”管理模式前（2016年度）与实施医保“行政MDT”管理模式后（2017年度）不同质控指标。结果：实施医保“行政MDT”管理模式后，医保患者平均出院时间、次均住院费用、平均住院日和住院药占比均降低，住院患者满意度提高，差异均有统计学意义。结论：实施医保“行政MDT”管理模式可以实现医保患者多科室联动管理，合理控制医保质控指标，节约医疗资源，控制医保基金不合理支出，提升医院管理水平。
Objective：To investigate the application and effect of Administrative MDT management mode in hospital medical-insurance management. Methods：The quality control indexes were compared between 2016 (not carrying out administrative MDT in hospital medical-insurance management) and 2017(carrying out administrative MDT ). Results：After the implementation of administrative MDT，the average discharge time，the average hospitalization cost，the average hospitalization day and the proportion of hospitalized drugs of medical insurance patients were significantly decreased（t=75.85，7.319，9.277，19.373，P < 0.01），and the satisfaction rate of hospitalized patients was significantly increased（t=8.496，P < 0.01）. Conclusions：The implementation of the “administrative MDT” management mode in hospital medical-insurance management can realize the coordinated management of multiple departments，reasonably control the quality control indexes of medical-insurance，save medical resources，control the unreasonable expenditure of medical-insurance funds，and improve the level of hospital management.