基于DRGs的四川省三级医院医疗服务质量与绩效评价研究

DRGs-based evaluation of medical service quality and performance at tertiary hospitals in Sichuan province

目的基于DRGs评价四川省18家三级医院2016年的医疗服务绩效情况，探讨医疗机构服务质量与绩效评价的客观方法。方法通过收集四川省18家三级医院2016年的病案首页数据，运用DRGs作为风险调整工具，从医疗能力、服务效率、医疗质量3个维度对其进行医疗服务质量与绩效评价。结果医疗服务能力评价中，出院病例数和总权重值最高的均为I医院（83405例，126522．22），最低的是G医院（2350例，2797．12）；DRGs组数最高的是B医院（661组），最低的是G医院（43组）；CMI值最高的是F医院（2．091），最低的是D医院（0．953），B、I、P医院覆盖的疾病类型范围较宽，F、B、I医院的整体技术难度水平较高。服务效率评价中，时间消耗指数最低的是E医院（0．740），费用消耗指数最低的是P医院（1．073）。服务质量评价中，低风险组和中低风险组死亡率均最低的医院是F和G医院（0．00％，0．00％）。综合得分最高的是I医院（100．0分），最低的是G医院（51．1分）。结论基于DRGs开展医疗机构的医疗服务质量与绩效评价，能在一定程度上保证评价的可靠性与科学性，有助于医疗质量的持续改进，且能为医疗服务监管提供数据支撑和决策参考。

Objective To evaluate the performance of medical services of 18 tertiary hospitals in Sichuan province in 2016 based on DRGs, to identify objective methods to evaluate service quality and performance of medical institutions. Methods Based on the homepage data of inpatient medical records from 18 tertiary hospitals in Sichuan in 2016, using diagnosis-related groups as a risk-adjustment tool, the study evaluated the medical service quality and performance from three dimensions： medical ability, service efficiency and medical Quality. Results In the evaluation of medical service capacity, hospital I had the highest number of discharged cases and total weight （83 405 cases and 126 522. 22）, and hospital G had the lowest discharge cases and total weight （2 350 cases, 2 797. 12）. The highest number of DRGs group was from hospital B （661 groups） , and the lowest from hospital G （43 groups）. The highest value of CMI was from hospital F （2. 091 ） , and the lowest from hospital D （0. 953）. Hospitals B, I and P had wide disease type range, while hospitals F, B and I had higher overall technical level than the other hospitals. Of the service efficiency evaluation, hospital E had the lowest time consumption index （0. 740） , and hospital P had the lowest expenditure index （ 1. 073）. Of the service quality evaluation, hospitals F and G had the lowest risk of mortality and the lower risk of mortality （0.00% , 0.00% ）, Hospital I had the highest total score （100.0 points）, and hospital G had the lowest total score （51. 1 points）. Conclusions DRGs based evaluation on medical service quality and performance of medical institutions can ensure reliability and scientific adequacy of evaluation. It may contribute to the continuous improvement of medical quality, and provide data support and decision reference for medical service supervision.