科室疑难危重患者识别方法

A New Method to Identify Patients with Miscellaneous Complicated Disorders and Patients with Critical Diseases

目的疑难危重患者识别一直是医院管理者关注的重点问题,但因对疑难危重患者特征难以提取及量化,尚缺乏令人信服的解决方案。方法将CCHI(《中国医疗服务操作项目分类与编码》)的项目与医院HIS(医院信息系统)系统内价表字典里的医嘱项目建立对照表,利用CCHI中各项目定义的技术难度、风险程度赋值作为患者疑难危重的间接量化指标,通过对各项目分值的测算,探讨疑难危重患者的识别方法。结果使用几类方法进行测算,其中采用最大值法对包含内、外科的试点科室进行疑难危重测算,心血管内科、神经外科平均综合得分分别为95.6分和89.9分,显示其疑难危重程度较重;神经内科平均分56.8分,其疑难危重程度较低。结论最大值法识别率略高,并且初步结果显示疑难危重综合分值的分布具有明显的规律性,可以作为患者疑难危重识别的一种方法。CCHI与HIS诊疗项目的对照存在许多困难,一定程度上影响本方法的应用。

Objective Identification of patients with miscellaneous complicated disorders and critical diseases has always been the focus of hospital administrators. Due to the difficulty in collecting and quantifying the characteristics of patients with miscellaneous complicated disorders and critical diseases, there is still a lack of convincing solutions. Methods A checklist was set up to link the diagnosis and treatment projects of CCHI to the doctor＇s advice projects from the price table of hospital HIS. The technical difficulties and the degree of risk of CCHI were assigned values based on the definitions in CCHI and taken as the indirect parameters to evaluate the difficult and critical diseases. The parameters were calculated to find the methods to identify the difficult and critical diseases. Results Several methods were used for calculation. The scores of the miscellaneous complicated disorders and critical diseases in the internal medicine department and surgical department were calculated by the max score method, The overall scores of the cardiovascular department of internal medicine and the neurosurgery department were 95.6 and 89.9 on average and the degrees of miscellaneous complicated disorders and critical diseases were higher. Neurology department averaged 56.8 with a relatively lower degree of miscellaneous complicated disorders and critical diseases. Conclusion The recognition rate obtained by the max score method is slightly higher, and the comprehensive score of miscellaneous complicated disorders and critical diseases presents obvious regularity in its distribution. It can be used as a method to identify the miscellaneous complicated disorders and critical diseases. The difficulties in comparing the diagnosis and treatment projects of CCHI and HIS may, to some extent, affect the application of this method.