基于变异系数赋权与功效系数的医院综合评价

Hospital comprehensive evaluation based on the variable coefficient of empowerment and efficacy coefficient

目的 为了解湛江市二级综合医院的医疗质量状况,对9家医院综合水平进行排序,找出某院与同行的差距,以及需要改进之处,为该院的发展提供决策依据.方法 从国家卫生统计信息网络直报系统提取2009年湛江市九家二级医院的直报数据,根据广东省卫生厅采用的指标公式整理并提取病床使用率、病床周转次数、平均住院日、病床工作日、有效率、病死率、住院危重病人抢救成功率、急诊抢救成功率、三日确诊率、入出诊断符合率、药品比例、平均每医生收治住院病人数、平均每医生负担诊疗人次、平均每诊疗人次医疗费、出院者平均每天住院医疗费等15个有代表性的医疗质量、效率指标.使用变异系数赋权与功效系数法,对这九家医院的上述指标进行综合评价.首先运用Excel求出标准差及变异系数,根据指标包含的信息确定权重,再计算功效系数,然后采用加权几何平均法计算出总功效系数,对结果进行排序.结果 A～I代表的九家医院医疗质量总功效系数分别为68.7、79.1、71.9、86.5、86.0、79.5、87.6、83.3、90.3.I单位平均住院日等4个指标排名第1,2个指标排第2,综合水平名列前茅;G单位病死率等3个指标排第1,平均住院日排第2,3个指标排第3,综合水平第2;A单位虽然出院者平均每天住院医疗费排第1,有效率排第2,但是病床使用率等权重较大的8个指标排在第8或9,综合水平排名最后.结论 A单位在医疗技术培训、抢救水平、外科及儿科建设、宣传等方面要加大力度,提升医疗质量.

Objective In order to understand the medical quality of Zhanjiang secondary comprehensive hospitals, Sor- ting on the comprehensive levels of nine hospitals, then to find the gap with counterparts and the improvement needed in a hospi- tal, and providing decision-making basis for the development of the hospital. Methods The data in 2009 of nine second grade hospitals were extracted from sanitation statistics system of the national health information network in accordance with the indicator formulae which was provided by guangdong health department, based on the data and indicator, 15 indicators was pointed out, such as bed utilization ratio, sickbed turnover times, the average hospitalization days, sickbed working days, effective rate, mor- tality rate, successful rescue rate of hospital seribusly ill patients, successful rescue rate of emergency, 3-days correct diagnosis rate, accuracy rate of diagnosis, drug proportion, average misdiagnosed presenting per doctor, average rate of outpatient visits per doctor, medical expenses per outpatient, and the daily average rate of hospitalization expenses. And then the comprehensive eval- uations were carried out, according to those indicators by means of variation coefficient and efficiency coefficient. First of all, standard deviation and coefficient of variation were computed with the use of Excel, and the weight was determined in accordance with those indicators. Next, the efficiency coefficient was determined. Then the weighted geometric mean method was adopted to calculate the overall effectiveness factor. Finally the results were sorted according to the sequence from top to bottom. Results The total efficacy coefficient of the medical quality of nine hospitals which were represented by A - I were 68.7, 79.1, 71.9, 86.5, 86.0, 79.5, 87.6, 83.3,90.3. Unit I had four indexes rank first, such as average hospital stay, etc. Two indexes took second places. And its comprehensive level was the front-runner. Unit G had three indexes first in line, such as fatality rate, etc. The average hospital stay ranked the second, and three indexes stayed at third places. Its comprehensive level was second. Although hospitalization expenses stayed at the first place, and effectiveness ranked second for Unit A, eight indexes which were weighted larger ranked in the eighth or ninth places, such as bed utilization, etc. So its comprehensive level was in the last place. Conclusion Unit A needs to make efforts and take improvements continuously in the medical technical training, rescue level, surgical and pediatric construction, and Publicity and so on.