Eight departments issued a text, did not enter the clinical path of drugs or large-scale elimination!

Medical network January 6 days ago, the National Health and Safety Commission and other eight departments jointly issued "on the further standardization of medical behavior to promote reasonable medical examination guidance" (hereinafter referred to as "guidance"), the National Health and Safety Commission will organize the formulation of national clinical guidelines, clinical technical practice norms, rational drug guidelines, clinical pathways.
by the end of 2022, 50% of discharged patients from level 3 hospitals and 70% of discharged patients from level 2 hospitals should be managed according to clinical pathways.
the effect of clinical path control significantly standardizes medical behavior and promotes rational medical examination is a key task of the CPC Central Committee and the State Council to deepen the reform of the medical and health system.
"Guidance" in the further standardization of medical behavior, pointed out that the National Health and Wellness Commission organized the formulation of national clinical guidelines, clinical technical practice norms, rational drug use guidelines, clinical pathways.
In accordance with the relevant regulations of the state industry management, will be clear and detailed norms of diagnosis and treatment of various diseases, drug guidelines, clinical pathways, etc., through electronic medical records, knowledge base, intelligent audit and other ways, electronic form embedded in the medical staff workstation, to promote reasonable examination, rational drug use, reasonable treatment.
the same time, focus on strengthening national monitoring of the use of drugs, antimicrobial drugs, anti-tumor drugs, cardiovascular drugs and other monitoring.
strengthen medical technology access, clinical path management and health technology assessment, and gradually improve the clinical path management entry rate, completion rate, reduce variation rate, exit rate.
by the end of 2022, 50% of discharged patients from level 3 hospitals and 70% of discharged patients from level 2 hospitals should be managed according to clinical pathways.
, the performance distribution system of medical institutions will be improved.
medical institutions are required to establish a public welfare-oriented performance distribution system, not to set indicators that may induce over-examination and over-medical treatment and link it to the income of medical personnel.
We should learn from the methods and experiences of disease diagnosis-related subgroups (DRGs) and resource-based relative value ratio (RBRVS), take technical level, difficult coefficient, quality of work, positive test result rate, patient satisfaction, etc. as the key evaluation index of performance distribution, so that the income of medical personnel truly reflects the value of labor and technology, and achieve excellent performance and reward.
Chinese medicine hospital should take the characteristic advantages of Chinese medicine as the key evaluation basis for performance distribution, and guide medical personnel to adhere to the direction of diagnosis and treatment based on Chinese medicine.
It is understood that the clinical path is mainly for a disease, or a certain surgery developed a scientific and chronological medical care plan, the core is a disease or surgery involved in the key examination, treatment, medication, care and other activities standardized.
in the eyes of the industry, the clinical path is an important technical grasper of the "three-doctor linkage", the implementation of clinical pathway can regulate the behavior of diagnosis and treatment, control the increase in the cost of medical services, and promote rational drug use.
recent years, the coverage of clinical path management has been expanding.
, nearly 7,000 public hospitals nationwide, or 88.5 percent of the country's public hospitals, had conducted clinical path management as of the first quarter of 2017, according to previous data.
data show that the proportion of inpatient drugs decreased significantly in most diseases of clinical path management, and the increase in the cost of hospitalization in the primary and secondary clinical path was basically lower than the rate of non-clinical pathway.
the accelerated landing of DRG/DIP is noteworthy, the clinical path also has the function of scientifically measuring medical expenses, and is one of the basic work to promote the reform of medical insurance payment methods.
the background of DRG's medical insurance payment reform, the importance of clinical path is more obvious.
2019, DRG will be piloted in 30 cities across the country under the leadership of the National Health Insurance Administration, and actual payments will be launched in 2021.
In October 2020, the State Health Insurance Administration issued the Pilot Work Programme on Total Budget of the Regional Points Method and The Payment of Disease Values, formally proposing dip, which explicitly requires that the total regional medical insurance budget be combined with the Points Method in 1-2 years' time to realize the multi-multi-composite payment method based on the payment of the disease points in hospital.
, the National Health Insurance Administration issued a list of pilot cities that pay by disease, covering 71 cities in 27 provinces and cities.
this year, DRG and DIP will accelerate the landing, the cost control of medical institutions to put forward a greater challenge, drugs, inspection will become the cost center of hospitals, medical institutions actively reduce the prescription and examination become the trend.
, on the one hand, cost-effective domestic drugs will become the main drug choice, on the other hand, auxiliary drugs, Chinese medicine, antimicrobial drugs, high-priced drugs and other use pressure will be further increased.
In recent years, in the area of drug administration, the national level has also been strengthening the management and monitoring of some categories, has issued to strengthen the clinical application management of antimicrobial drugs, the first batch of national key monitoring of rational drug use drug catalog, "two diseases" drug management and other related documents.
, the National Health and Wellness Commission also issued the "Clinical Application Management Measures for Anti-Tumor Drugs (Trial)", will combat cancer drugs to implement drug classification management, emphasizing the evidence-based use of drugs.
drug use of these categories has become the focus of drug management in medical institutions.
In promoting reasonable medical examination, the Guidance proposes that the establishment of a key monitoring directory and abnormal early warning system will be explored to focus on the monitoring of higher-cost inspection items and obviously unreasonable inspection behavior.
and carry out a one-year special management action for unreasonable medical examination.
The health and health departments will work with relevant departments such as market supervision and medical insurance to formulate work programmes, clarify the key contents of governance and related requirements, comprehensively organize and carry out self-examination and self-correction of medical institutions, supervision and inspection by local authorities, organize experts to take flight inspection, spot checks, random spot checks and other ways to supervise and manage, focusing on rectification of unfounded inspections and repeated inspections.
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