标准化专科病例组合指数的研究与应用

Research and application of standardized specialty case-mix index

目的:分析患者病组构成差异对病例组合指数(case-mix index,CMI)的影响,探索对其进行标准化的调整方法。方法:以2018年深圳市感染性疾病患者住院病案首页信息为数据来源,描述病组的分布构成,采用全市水平的感染性疾病专科患者DRGs占比作为标准构成,对各医院的感染性疾病专科CMI予以标化调整。结果:19家样本医院感染性疾病患者主要诊断类别分布差异具有统计学意义(χ^2=6367.724,P<0.001),CMI调整前后有14家医院的顺位排序发生变化,标化前后医院总体水平CMI的变异系数由14.32%降至12.26%。结论:基于患者病组分布调整的标准化专科CMI,对医院之间例均资源消耗水平相对差异的反映可能更接近临床实际。在专科医疗服务评价中,使用CMI宜考虑指标结果的可比性。

Objective:To analyze the association between patient groups by diagnosis and case-mix index(CMI),and to explore the method of CMI standardization.Methods:Research data were obtained from the medical record summary of hospitalized patients with infectious diseases in Shenzhen in 2018,this paper described the patient distribution by DRGs,the proportion of cases by DRGs on the overall level was used as standard cases distribution of infectious patient to adjust the value of specialty CMI of infectious disease in each sampled hospital.Results:There was a statistically significant difference among major disease category(MDC)distribution in hospitals with hospitalized infectious disease patients(χ^2=6367.724,P<0.001).The ranking of 14 hospitals changed after CMI adjustment than before.The coefficient of variation of CMI on the overall level decreased from 14.32%to 12.26%after the standardization adjustment process.Conclusion:Measure of specialty case-mix index based on standardization of patient groups distribution may reflect the relative difference level of per-case resource consumption between hospitals,and the result would be more similar to the clinical reality.The comparability of results should be considered when utilizing CMI to the evaluation of specialized medical service line.