云南省三级医院基于DRGs的医疗服务绩效评价研究

DRGs-based medical performance evaluation of tertiary hospitals in Yunnan

目的 探讨医疗机构服务绩效评价的客观方法和促进医疗服务机构服务效率的手段.方法 通过采集云南省10家三级医院2012年的病案首页数据,运用北京版诊断相关组（BJ-DRGs）作为风险调整工具,对其进行医疗服务绩效评价.结果 本研究从医院的产能、效率和医疗安全3个维度对10家医院的医疗服务能力进行综合评价.结果显示,出院病例数和总权重值最高的均为A医院（77 458例,104 227.5）,最低的是工医院（25 450例,38 162.28）;A、B和D等医院与其他医院相比,DRG组较多,而E、Ⅰ医院的病例组合指数（CMI）值较高；C医院的费用消耗指数与时间消耗指数最低（0.935 9,0.851 4）；B、C和D医院低风险组病例死亡率最低（0.01％）；F医院最高（0.08％）.结论 DRGs这一风险调整工具可显著地提高医疗服务绩效评价的可靠性、科学性和持续性；同时为云南省等级医院评审提供了可靠的基础数据.

Objective To identify objective methods for medical service performance evaluation, and means to improve the efficiency of medical services. Methods By means of collection of medical records from 10 tertiary hospitals in Yurman in 2012, and Diagnosis-related groups of Beijing version（BJ- DRGs）as a risk-adjustment tool, medical service performance was made to such hospitals. Results The capacity, efficiency and medical safety of hospital of the hospitals were subject to a comprehensive evaluation of their medical service capabilities. In terms of discharged inpatients and total weight,hospital A were found to be the highest（77 458 cases, 104 227.5 respectively）, and hospital I the lowest（25 450 cases, 38 162. 28）among these hospitals in 2012; compared with other hospitals, DRG groups of hospitals A,b and D were found higher, while the case mix index（CMI）of hospitals e and I were higher. The expenditure index of hospital C is the lowest（0. 9359, 0. 8514）; the mortality in cases of low risk of hospitals B, c and D were the lowest, while hospital F was the highest. Conclusion DRGs as a risk adjustment tool, can significantly improve the reliability, science and continuity of medical service performance evaluation, providing reliable basic data for hospitals accreditation in Yurman.