应用TOPSIS法与RSR法综合评价医院医疗质量

Comprehensive evaluation of medical quality with the use of TOPSIS and RSR

目的 对某院住院医疗工作质量进行综合评价,了解其变化趋势,为加强医院管理提供客观、科学的决策依据.方法 应用TOPSIS法与RSR法2种不同的统计学方法 对该院2001-2010年住院部的9个有代表性的医疗质量管理指标进行统计学分析.应用Excel进行TOPSIS评价,建立评价指标的数据矩阵,采用倒数法将评价指标数据同趋势化,并使数据归一化.确定指标的最优值和最劣值,分别构成最优值向量Z＋和最劣值向量Z-,计算各评价单元指标值与最优值和最劣值的距离,计算各评价单元指标与最优值的相对接近程度（C值）,按接近度大小对各评价单元优劣进行排序,C值越大,表明被评价对象越接近最优水平.采用RSR法进行评价时,病死率、院内感染率和平均住院日为低优指标,其余按高优指标进行编秩.根据RSR法计算公式求出被评价对象的Y值,运用最佳分档准则,结合合理分档数表,得出各年度医疗质量分档排序结果.结果 医疗质量最优的是2009年、2008年,表现为良的是2010年、2007年、2006年,较差的是2002年和2001年.评价结果 与医院发展的实际情况相一致,医疗综合质量呈逐年上升趋势.结论 TOPSIS法简单易行,在医疗工作质量综合评价中的应用具有灵活性和广泛性;与RSR法相结合能科学地、真实反映评价结果,评价结果 为医院医疗质量管理提供了可靠的信息,为医院建设起到价值导向作用.

Objective To evaluate comprehensively the medical quality in one hospital, to understand the trends, and to provide objective, scientific basis for the decision making of the hospital management. Methods With the use of TOPSIS and RSR, Nine medical quality indexes of inpatient department were selected to evaluate comprehensively their medical quality from 2001 to 2010. The TOPSIS method was conducted with Excel, data matrix of these evaluation indexes was established, and the reciprocal method was used to normalize the decision matrix. The ideal and negative-ideal value were determined to constitute the ideal vector （ Z＋ ） and the negative-ideal vector （ Z- ） respectively, the Euclidean distances of each alternative from the ideal val- ue and the negative-ideal value were calculated respectively, the relative closeness of each alternative to the ideal value（ C value） was calculated, and the alternatives were ranked according to C value, the bigger the C value, the better the alternative. With RSR method, the mortality rate, nosocomial infection rate and average hospitalization days were negative-ideal indexes while oth- ers were ranked by ideal indexes. In order to assess the annual medical quality, Y value of the object being evaluated was calcu- lated with the use of the RSR formula, and the best classification criterion combined with reasonable grading tables were used to get the rank results. Results The best medical quality was in 2009 and 2008, the better was in 2010, 2007, 2006 and the worst was in 2002 and 2001. The evaluation results consist with the actual development of the hospital and medical quality shows an upward trend year by year. Conclusion The TOPSIS method is simple and practical and it has the flexibility and universality in the comprehensive evaluation of the medical quality. The combination of the TOPSIS and the RSR can reflect the evaluation truly and scientifically. The evaluation results have provided reliable information for the medical quality, and can play the value-orien- ted role of the hospital construction.