基于DRGs数据的死亡病例分析

Analysis of Death Cases Based on DRGs

目的分析某三甲医院2015年1月—2017年12月基于疾病诊断相关分组(Diagnosis Related Groups,DRGs)数据的死亡病例特点,为医院医疗质量管理提供依据。方法将某院2015年1月—2017年12月出院患者首页数据导入CN-DRGs分组器,将入组的死亡病例按风险等级进行分类,比较总体死亡率、各风险组死亡率变化,分析相关的首页数据质量和存在的问题。结果 3年总死亡率差异无统计学意义(P> 0. 05);低风险组、中低风险组死亡率差异无统计学意义(P> 0. 05),中高风险组死亡率逐年下降,差异有统计学意义(P <0. 001); 2016年高风险组死亡率升高,差异有统计学意义(P <0. 05)。2015年有6个专业死亡率大于1%,2016年和2017年有7个专业死亡率大于1%,专业MDCT、MDCU、MDCW 3年内无死亡病例。低风险死亡病例主要分布在MDCO、MDCI、MDCF及MDCN专业,高风险死亡病例数前6位专业为MCDF、MCDG、MCDB、MCDI、MCDH、MCDE;中高风险死亡病例数前6位专业MCDL取代了MCDI。结论医院管理者要加强对低风险组患者的医疗安全监管,提高高风险组患者的诊治能力;加强临床医师首页填写和编码员技能培训,提高首页质量。

Objective To explore the characters of deaths based on DRGs in recent three years from January 2015 to December 2017 in a Class one Grade A hospitals. Methods Transplant related data about discharged patients from January 2015 to December 2017 into burster CN-DRGs. The deaths were categorized according to risk levels and the changes of the overall death rates were compared across groups of different risk levels. Then, the quality and problems of homepage data were analyzed.Results The total mortality rate for these three years clearly showed no statistical disparity （ P 〉0.05）. There were no significant differences between the low risk group and low-medium group in terms of the mortality rate for the three years （ P 〉0.05）. The mortality rate of medium-high risk mortality rate dropped significantly （ P 〈0.001）, and the high-risk level in 2016 rose dramatically （ P〈 0.05）. The mortality rate of six fields was greater than 1% in 2015, while that of seven fields more than 1% in 2016 and 2017. The fields including MDCT, MDCU, MDCW showed no deaths in recent three years. Low-risk deaths happened mainly in the fields of MDCO, MDCI, MDCF and MDCN. The top fields with high-risk deaths are the six ones of MCDF, MCDG, MCDB, MCDI, MCDH and MCDE. Among the top six fields with middle-high-risk deaths, MEDL was ranked the first instead of MCDI.Conclusion The hospital’s administrators need to promote medical security supervision and boost doctor’s treatment for high-risk patients. Meanwhile, the hospitals also should contribute to the quality of the front page of clinical doctors and training coding clerks.