基于DRGs的手术质量评价模型在儿外科的应用

Application of DRGs-based surgical quality measurement model in pediatric surgery

目的:儿外科手术因手术难度高、风险大,手术质量控制与评价困难。考虑到手术难度与手术质量的评价和疾病严重度密切相关,设计构建新型儿外科手术质量评价模型,用于评估儿外科手术质量。方法:将疾病严重度(severity of illness,SOI)作为手术质量评价的重要参数,查阅相关文献,历史数据回顾分析,初步确定SOI评估指标,采用网络分析法计算各指标的权重值;并将合并手术及合并症对手术结局的影响纳入模型,参考APR-DRGs为每种疾病和手术赋予权重。通过真实数据校正模型中各因子的β系数。结果:模型在北京市某三级甲等儿童专科医院予以应用,用于比较8个手术科室间的手术复杂度和手术质量评分,验证了模型的可行性。结论:儿外科手术评价模型基于疾病严重度、手术难度、院内资源消耗度的手术质量综合评价方法,为实现不同医院、不同科室、不同医生间的儿外科手术质量评价提供了一种的新方法。

Objectives: There is non-successfully implemented method to conduct pediatric surgery quality and performance measurement because of the high complexity and high surgical risk. The serious degree and quality assessment is highly related to SoI. To meet the need for pediatric surgery quality management an innovative pediatric surgery quality measurement model is designed and constructed to measure pediatric surgery quality and performance score across different pediatric surgical departments. Methods: By reviewing, finding that SoI is an important factor for surgical quality evaluation. Based on retrospective data analysis, determining a group of indicators related to SOI, then using ANP (network analysis method) to construct executable pediatric surgery quality measurement model, then calculating weighted values for each indicator. Referencing All Patient Refined DRGs (APR-DRGs) and analyzing historical data, calculating complexity score for every surgical DRGs and then corresponding comorbidities weight. The beta coefficient of each factor in the model is corrected by using large volume of real data on pediatric surgery. Results: The model was tested using real data from eight surgical departments of a tertiary children’s hospital in Beijing. Conclusions: The pediatric quality measurement model is an innovative method which fulfills the need of pediatric surgery quality measurement between hospitals, surgical departments or individuals.