深圳市市属三级医院住院医疗服务综合评价对比分析--基于DRGs与DMIAES疾病风险调整模型研究

Comparative Analysis of Comprehensive Evaluation of Inpatient Medical Services of Municipal Tertiary Hospital in Shenzhen City:Based on DRGs and DMIAES Disease Risk-Adjusted Model

目的使用DRGs和疾病管理智能分析和评估系统(Disease Management Intelligent Analytic and Evaluation Sys-tem, DMIAES)疾病风险调整模型从医疗质量、工作效率、费用控制多个维度对住院医疗服务进行综合评价,分析两种方法的区别,为医院持续改进提供合理的管理目标和精细的评价方法。方法对深圳市市属8家三级医院2015年的出院患者进行DRGs分组后,建立DMIAES疾病风险调整模型,再利用模型对2016年出院患者的病死率、住院日和住院费用进行预测和评价,并利用DRGs相关评价指数分析同期数据。结果 DRGs相关评价指数与DMIAES结果有所不同,后者经过疾病风险调整后,得到8家医院的ACMI值以及住院日和住院费用的O/E值,提示各家医院在住院医疗质量方面均有所改进,但大部分医院在费用控制和住院日管理方面尚有提高空间。结论 DMIAES用数学建模的方法,对出院患者进行疾病风险调整,在此基础上进行医疗服务的综合评价,更为公平、合理,更有利于医院的持续改进。

Objective The DRGs and DMIAES disease risk-adjusted model were used to evaluate the inpatient medical service from the medical quality,work efficiency and cost control.The difference between the two methods was analyzed,and the rational management goals and the fine evaluation methods were provided for the continuous improvement of the hospital.Methods After DRGs grouping the discharged patients in 8 public hospitals of Shenzhen in 2015,the DMIAES disease risk-adjusted model was established,and the mortality rate,length of stay and medical cost of discharged patients in 2016 were predicted and evaluated by using the model.The related evaluation index of DRGs was used to analyze the data of the same period.Results The related evaluation index of DRGs is different from that of DMIAES.After the disease risk adjustment of DMIAES,the ACMI value,the O/E value of length of stay and medical cost of 8 hospitals were obtained.It showed that all hospitals had improved the quality of hospitalization,but there was still room for improvement in cost control and length of stay.Conclusion DMIAES uses the method of mathematical modeling to adjust the disease risk of discharged patients.On the basis of this,the comprehensive evaluation of medical services is more fair and reasonable,which is more conducive to the continuous improvement of the hospital.