医院核心病种诊疗绩效分析及其在学科评价中的应用--基于DMIAES疾病风险调整模型研究

Performance Analysis of Hospital Core Diseases Diagnosis and Treatment and its Application in Discipline Evaluation:Based on Disease Risk Adjustment and its Application in Subject Evaluation

目的探讨基于诊疗复杂度和疾病严重程度校正的核心病种评价专科水平及服务能力的方法。方法使用疾病管理智能分析和评估系统(Disease Management Intelligent Analytic and Evaluation System,DMIAES)对深圳市市属12家公立医院2015年出院患者病案首页数据针对死亡率、住院天数、费用分别建模,在此基础上,再对2016年出院病案首页数据进行评价,以心血管内科、神经外科2个专业学科的评价为例,通过对核心病种及关键技术的ACMI、ACMP,死亡O/E,住院天数O/E,总费用O/E综合分析,来评价学科的临床服务水平及技术能力,并与深圳市品牌学科对比。结果通过对疾病风险调整后的核心病种和关键技术评价的评价结果比较,对22个专业24个品牌学科进行了评价,专业排名第一位的品牌学科10个,占比41.67%,排名第二位的7个,占比29.17%;排名第三位的3个,占比12.5%;排名低于前三位的4个,占比16.67%。结论使用基于核心病种的绩效评价系统,能可观、公正、科学地评价学科的临床服务能力及技术水平,并建议推广。

Objective To explore the methodology for the evaluation on the specialty level and service capacity of hospital core diseases based on diagnosis and treatment complexity and disease severity correction.Methods Using Disease Management Intelligent Analysis and Evaluation System(DMIAES),the first page data of hospital discharge patients of 12 public hospitals in Shenzhen in 2015 were respectively modeled for mortality,hospitalization days and expenses,the home page data of the hospital discharge patients in 2016 were evaluated.Taking the evaluation of cardiovascular medicine and neurosurgery as examples,the clinical service level and technical ability of the subjects were evaluated through the comprehensive analysis of the core diseases and ACMI,ACMP,death O/E,hospitalization days O/E and total expense O/E of key technologies,and at the same time,the subjects were compared with the brand disciplines of Shen?zhen Medical Management Center.Results By comparing the evaluation results of the core diseases and key technologies after the adjustment of the disease risk,24 brand disciplines of 22 majors were evaluated,with 10 brand disciplines ranked first in the major,accounting for 41.67%;7 subjects ranked second,accounting for 29.17%;3 in third place,accounting for 12.5%;3 ranked below the top three,accounting for 16.67%.Conclusion Using the performance evaluation system of hospital core diseases can evaluate the clinical service ability and technical level of specialized subjects in a fair and scientific way,and it is recommended to be popularized.