CN-DRGs与传统住院指标在科室绩效评价中的比较

Comparison of CN-DRGs and Traditional Hospitalization Indicators in the Evaluation of Performance of Departments

目的比较CN-DRGs指标与传统住院指标在科室绩效评价中的差异,为科室综合评价提供依据。方法收集某三级综合医院27个住院科室2019年1月1日-2019年12月31日住院病案首页43395份,通过2个系统分别生成CN-DRGs指标与传统住院指标,从服务能力、服务效率、医疗安全3个维度进行归类。采用CN-DRGs(2016版)分组器对住院病案首页数据进行主要诊断类别和DRGs分组,剔除超过60天或住院费用小于100元、QY病案,共43065份入组,生成CN-DRGs指标:总权重、床均权重、CMI、费用消耗指数、时间消耗指数、中低风险死亡率;43395份住院病案首页生成传统住院指标:出院人次、病床周转次数、危重患者比率、平均住院费用、平均住院日、死亡率6个指标。运用非整秩次秩和比法对27个科室的2类指标进行排序及比较。结果27个住院科室的CN-DRGs指标与传统住院指标非整秩次编秩结果对比存在一定的差异,按3个档分类结果为14个科室一致,13个科室不一致。2类指标进行秩合检验,经分析处理Z=-0.580,P=0.562>0.05,差别无统计学意义,说明2类指标排序无统计学意义。结论2类指标评价住院科室年度绩效各有优劣,既考虑了传统住院指标工作强度,又填补了病种和治疗方式的差异和难易程度,2类指标综合评价科室绩效可信度强,值得借鉴。

Objective To compare the differences between CN-DRGs indicators and traditional hospitalization indicators in department performance evaluation.Methods To selected 27 inpatient departments of a tertiary general hospital as the research object.Col lection of 43395 front pages of hospital medical records from January 1 st,2019 to December 31 st,2019,and generated the CN-DRGs index and the traditional hospitalization index respectively through two systems,which were classified from three dimensions:service ability,service efficiency and medi cal safety.The main diagnosti c categories and DRG of the first page data of inpati ent medi cal records were grouped by usi ng CN-DR Gs(2016 version)cluster,excluding more than 60 days or lessthan 100 yuan in hospital expenses,atotal of 43065 cases were QY into the group to generate CN-DRGs indicators:total weight,bed weight,CMI,cost consumption index,time consumption index,medium and low risk mortality;4395 front pages inpatient medical records generated traditional hospitalization indicators:discharge times,hospital bed turnover times,critical patient ratio,average hospitalization cost,average hospitalization days,death rate 6 indicators.The non-integral rank sum ratio method was used to sort and compare the two kinds of indexes in 27 departments.Results To compared with the non-integrated rank of the traditional hospitalization index,the CN-DRGs index of 27 from those of the traditional ones.The rank sum test was performed on two kinds of indexes,and the difference of Z=-0.580,P=0.562>0.05,was not statistically significant,which indicated that the ranking of the two kinds of indexes was not statistically significant.Conclusions The two kinds of indexes had their own advantages and disadvantages to evaluate the annual performance of the inpatient department,which not only considers the working intensity of the traditional hospitalization index,but also filled in the difference and difficulty degree of the disease type and the treatment mode.The comprehensive evaluation of the perforrmance of the two ki nds of i ndexes has strong credibility and was worthy of reference.