疾病风险调整在“冠状动脉搭桥术”专科评价中的应用——基于DMIAES疾病风险调整模型研究

Application of Disease Risk Adjustment in the Evaluation of Coronary Artery Bypass Grafting:Based on DMIAES Disease Risk Adjusted Model

目的运用疾病管理智能分析和评估系统(Disease Management Intelligent Analytic and Evaluation System,DMIAES)疾病风险调整模型相关指标对临床专科进行综合评价,为学科建设提供建议。方法对成都市19家三甲综合医院2016年-2017年出院患者进行DRGs分组后,建立疾病风险调整模型,再利用模型计算出2018年的预测值,与2018实际值进行比较和评价,以心血管外科系统"冠状动脉搭桥术"专科为例进行专科分析和综合评价。结果经过疾病风险调整和关键技术评价比较,ACMI值提示6家医院"冠状动脉搭桥术"专科医疗服务能力及技术水平差异不大,均有改进空间;住院天数及总费用O/E,提示大部分医院"冠状动脉搭桥术"专科住院天数及住院费用压缩空间;病死率O/E提示C、F医院"冠状动脉搭桥术"专科应该提高医疗质量。结论 6家研究医院"冠状动脉搭桥术"专科医疗救治服务能力与技术水平差异不,在救治能力和技术水平相差不大情况下,要发挥其优势,应注意保持服务效率和医疗安全优势的同时,要增加"冠状动脉搭桥术"专科患者的收治,并且控制好住院患者的费用。

Objective The Disease Management Intelligent analysis and Evaluation System(DMIAES) was used to evaluate the clinical specialty comprehensively, and to provide suggestions for the discipline construction. Methods DRGs were divided into groups of patients discharged from 2016 to 2017 in 19 third-class general hospitals in Chengdu, and a disease risk-adjusted model was established, and then the predicted value in 2018 was calculated by the model, and compared with the actual value in 2018, a case study of coronary artery bypass grafting(CABG) in cardiovascular surgery system was analyzed and evaluated. Results After adjustment of disease risk and evaluation of key techniques, ACMI value indicated that there was no significant difference in the ability and technical level of coronary artery bypass grafting in 6 hospitals, and there was room for improvement in terms of length of stay and total cost O/E, it is suggested that the length of stay and cost of coronary artery bypass grafting should be Crush in most hospitals, and the mortality rate O/E suggests that the quality of care should be improved in coronary artery bypass grafting in C and F hospitals. Conclusion There is no difference in the service ability and technical level of "coronary artery bypass grafting" in six research hospitals, so we should give full play to its advantages when the service ability and technical level are not very different, while maintaining service efficiency and medical safety, we should increase admission of coronary artery bypass grafting(CABG) patients and control the cost of inpatients.