主要诊断组数据结构调整后的费用消耗指数在医院间评价中的应用

Adjusted cost consumption index of major diagnosis-related group data in hospital medical performance evaluation

目的探讨主要诊断分类（MDC）调整后的费用消耗指数计算方法，以便更合理地利用DRGs指标进行医院绩效评价。方法比照DRGs指标体系中CMI值的调整方法，详细对比广东省2家医院（S医院和Y医院）MDC调整前后的费用消耗指数差异，并进一步比较广东省内82家三级综合医院MDC调整前后的费用消耗指数排名差异。结果按传统算法，S医院的费用消耗指数高于Y医院（1．30〉1．28）；而按MDC调整算法，S医院的费用消耗指数明显低于Y医院（1．31〈1．38）。82家三级综合医院的指数排名也发生了较大变化，证实了费用消耗指数和CMI一样，都会受到MDC例数构成的影响。结论将MDC调整后的费用消耗指数应用于医院间绩效评价，得到的评价结果更稳定、合理。因此认为调整的费用消耗指数在医院绩效评价中有较大的实际应用价值。

Objective To study the calculation of the cost consumption index adjusted with major diagnostic classification （MDC）, for optimal use of DRGs index in hospital performance evaluation. Methods The adjustment method of CMI value in DRGs index system was used as reference, and we compared the different cost consumption indexes （both MDC adjusted and non-adjusted） of two hospitals （S and Y） in Guangdong province. Then we compared the different rankings of 82 tertiary general hospitals in the province before and after the adjustment. Results The cost consumption index of S hospital was higher than that of Y hospital by the non-adjusted method （1.30 〉 1.28）. But as calculated by the adjusted method, the index of S hospital was significantly lower than Y hospital （ 1.31 〈 1.38）. The rankiugs of these 82 hospitals also showed major changes, which prove that the cost consumption index, the same as CMI, will be affected by MDC cases makeup. Conclusions The MDC adjusted cost consumption index, when applied to hospital performance evaluation, renders more stable and reasonable results. This is an evidence that the adjusted cost consumption index is of great practical value in hospital performance evaluation.