DRGs评价三级综合医院心肌梗死救治能力的应用

DRGs Applied to Evaluate and Analyze the Treatment Ability of Myocardial Infarction in a Tertiary General Hospital in Beijing

目的运用DRGs对医院心肌梗死救治能力变化进行分析,评价胸痛中心建设对提升心肌梗死救治能力的有效性,为医院决策提供支持。方法北京市某三级综合医院2017年1月1日-2018年12月31日上传至北京市DRGs住院服务绩效管理平台2年住院病案首页主要诊断包含心肌梗死的所有数据,针对DRGs能力指标、效率指标、质量与安全指标等,采用SPSS17.0统计软件进行分析,计量资料采用±s描述,计数资料采用相对数描述,统计推断采用χ^(2)、F检验和秩和检验,P<0.05为差异有统计学意义。结果 2017年和2018年2年入组病例分别为319例、392例,男性占比分别为67.4%、71.7%,60岁及以上的老年人占比分别为70.5%、70.2%,性别和年龄构成在统计学上认为无显著性差异(分别为χ^(2)=1.531a、F=0.629,均P>0.05);总权重数分别为696.9、851.2,位列前3位的病组权重值占比分别为80.8%、76.6%,统计学有显著性差异(χ^(2)=62.452,P<0.05),CMI值分别为2.13、2.17;时间消耗指数均为1.19,费用消耗指数分别为1.02、0.98;低风险死亡率均为0,再入院例数分别为31例、32例,再入院率分别为9.7%、8.2%,统计学无显著性差异(χ^(2)=0.526,P>0.05)。结论医院治疗心肌梗死疾病复杂程度提高,费用指标改善,质量与安全指标提升,整体心肌梗死救治能力不断提升,但时间效率仍有改善空间,需研究对策持续改进。

Objectives DRGs was used to evaluate and analyze the changes in the treatment capacity of the hospital for myocardial infarction, and to evaluate the effectiveness of Chest Pain Center Construction to improve the rescue ability of myocardial infarction in order to provide support for hospital decision-making. Methods In the medical record system of a tertiary general hospital in Beijing, patients discharged from hospital in 2017 and 2018 were mainly diagnosed and selected to upload cases containing "myocardial infarction" to Beijing DRGs inpatient service performance management platform. For the DRGs capacity, efficiency, quality and safety indicators, using SPSS 17.0 statistical software analysis, measurement data using ±s description, the statistical data were described in relative numbers, and statistical inference was performed by chi-square test, F test and Rank sum test, P<0.05 was statistically significant. Results Compared with the same period of 2017 and 2018,the number of cases analyzed was 319 and 392, men accounted for 67.4% and 71.7%, aged 60 and above the elderly accounted was 70.5% and 70.2%, gender and age composition thought there was no significant difference in statistics(respectively χ^(2)= 1.531 a, F = 0.629, P>0.05). The total weight of the myocardial infarction DRG group was 696.9 and 851.2. The first three groups of myocardial infarction DRG group was 80.8% and 76.6%,statistical analysis showed significant difference(χ^(2)=62.452 a,P<0.05). The CMI value was 2.13 and 2.17. The time consumption index was 1.19 and 1.19, cost consumption index was 1.02 and 0.98. Low risk of mortality was 0, readmission were 31 and 32, readmission rates was 9.7%, 8.2%, statistical analysis showed no significant difference(χ^(2)= 0.526 a, P> 0.05). Conclusions Myocardial infarction disease treatment complexity of hospital had been increased, cost index had been improved, the indicators of quality and safety index had been increased, the overall myocardial infarction treatment ability had been improved. Therefore, there was need for the hospital to continuously strengthen management for improving in the time efficiency index.