Asadi Farkhondeh, Sabahi Azam, Ramezanghorbani Nahid, Emami Hassan
Department of Health Information Technology and Management, School of Allied Medical Sciences Shahid Beheshti University of Medical Sciences Tehran Iran.
Department of Health Information Technology, Ferdows School of Health and Allied Medical Sciences Birjand University of Medical Sciences Birjand Iran.
Health Sci Rep. 2023 Feb 14;6(2):e1115. doi: 10.1002/hsr2.1115. eCollection 2023 Feb.
Implementing the diagnostic-related groups (DRGs) promotes the efficiency of healthcare. Therefore, the present study aimed to identify the challenges facing implementing the DRGs in Iran.
The present study is a strategic applied research conducted in two phases. In the first phase, the challenges facing DRGs were extracted through a literature review. Then the collected data is entered into a checklist consisting of five sections including technological, cultural, organizational, strategic, and natural challenges. In the second phase, data were collected by purposive sampling and semistructured interviews with 10 managers of the Medical Services Organization of Tehran, Iran. Data analysis was performed by conventional content analysis using MAXQDA software and descriptive using SPSS software version 19.
The challenges facing the implementing DGRs from the experts' perspective included technological, organizational, nature, strategic, and cultural in order of priority. The three main fundamental challenges were reported; lack of integrating the DGRs with health information system (70%), frequent changes of management (70%), reducing the quality of care following early patient discharge (60%).
The results of the present study showed that the DRG system faced with challenges and healthcare officials should apply policies and guidelines to reform the system before changing the reimbursement system in Iran. By considering the leading countries experiences in the nationalizing the DRG system field, the problems and solutions of the system can be identified and aid in the more successful implementation of these systems.
实施诊断相关分组（DRGs）可提高医疗保健效率。因此，本研究旨在确定伊朗实施DRGs面临的挑战。
本研究是一项分两个阶段进行的战略应用研究。在第一阶段，通过文献综述提取DRGs面临的挑战。然后将收集到的数据输入到一个由技术、文化、组织、战略和自然挑战五个部分组成的清单中。在第二阶段，通过目的性抽样和对伊朗德黑兰医疗服务组织的10名管理人员进行半结构化访谈来收集数据。使用MAXQDA软件通过常规内容分析法进行数据分析，并使用SPSS软件版本19进行描述性分析。
从专家角度来看，实施DGRs面临的挑战按优先级依次为技术、组织、自然、战略和文化。报告了三个主要的根本挑战；DRGs与健康信息系统缺乏整合（70%）、管理频繁变更（70%）、患者早期出院后护理质量下降（60%）。
本研究结果表明，DRG系统面临挑战，伊朗医疗保健官员在改变报销系统之前应应用政策和指南来改革该系统。通过考虑DRG系统领域领先国家的经验，可以识别该系统的问题和解决方案，并有助于更成功地实施这些系统。
