成都市二级公立和民营综合医院住院医疗服务对比分析

Comparative analysis of inpatient medical services between secondary public and private general hospitals in Chengdu

目的采用疾病风险调整模型对二级公立和民营综合医院进行住院医疗服务综合评价与对比分析,探讨疾病风险调整模型在不同所有制医院医疗服务评价中的应用。方法基于成都市2017年和2018年1032865份病案首页,应用疾病管理智能分析和评估系统建立以病死率、平均住院日、住院总费用、医疗服务费用、药品费用和手术耗材费用作为因变量、相关影响因素作为自变量的回归模型,计算风险调整后的病例组合指数(ACMI),对病死率、平均住院日、住院费用等指标进行风险预测,分别得出公立及民营二级综合医院各指标的实际值与预测值的比值(O/E值)并进行比较分析。结果二级公立综合医院ACMI值为4.63,略高于民营医院的4.55,救治患者的技术难度和资源消耗略高于民营医院;从O/E值来看,二级公立医院对疾病病死率、医疗服务费用和住院药品费用管理总体较好,各二级民营综合医院住院费用等指标的O/E值差别较大,存在费用不合理的可能性;二级公立综合医院手术耗材费用O/E值为1.54,费用管理上存在改进空间。结论疾病风险调整模型充分考虑了不同机构收治患者的疾病类型和严重程度不同不能简单比较的特征,以个体病例为建模基础,实现了不同所有制医院的可比性,为医疗服务能力和质量评价提供了新的手段。

Objective To evaluate and compare the inpatient medical services of secondary public and private general hospitals by using disease risk adjustment model,and to explore the application of disease risk adjustment model in medical service evaluation of different ownership hospitals.Methods Based on 1032865 front pages of medical records in Chengdu in 2017 and 2018,a regression model with mortality,average length of stay,total hospitalization expenses,medical service fees,drug costs and surgical consumables costs as dependent variables and related influencing factors as independent variables was established by using disease management intelligent analytic and evaluation system.The risk adjusted case mix index(ACMI)was calculated.The mortality,average length of stay,hospitalization expenses and other indicators were predicted.The ratio of observed value to expected value(O/E value)of each index in public and private secondary general hospitals was obtained and compared.Results The ACMI value of secondary public general hospital was 4.63,slightly higher than that of private hospitals(4.55).The technical difficulty and resource consumption of the public hospitals were slightly higher than that of the private hospitals.From the O/E value,the management of disease mortality,medical service fees and inpatient drug costs of secondary public hospitals was generally good,and the O/E values of hospitalization expenses of each secondary private general hospital were quite different,and there was a possibility that the costs were unreasonable.The O/E value of surgical consumables cost in secondary public general hospital was 1.54,and there was room for improvement in cost management.Conclusions The disease risk adjustment model fully considers the characteristics of different types and severity of diseases in different institutions,which can not be simply compared.Based on individual cases,it realizes the comparability of different ownership hospitals,and provides a new means for the evaluation of medical service ability and quality.