基于风险调整的医疗绩效动态综合评价的探索

Exploration of Dynamic Comprehensive Evaluation of Medical Performance Based on Risk Adjustment

目的通过基于风险调整质量评价模型的构建,从医疗质量、工作效率、费用控制等多个维度对科室进行评价,为医院持续发展提供数据支持。方法利用某公司DMIAES产品工具计算各住院科室疾病风险调整后的病例组合指数值、风险调整后总权重,实际值与预测值之比(死亡率O/E值、住院日O/E值、总费用O/E值),使用TOPSIS法对26个住院科室进行动态综合评价。结果2016—2019年该院住院服务情况逐年提升,总体费用控制较稳定,医疗质量、医疗效率均逐年提高,各科室贡献水平不同,2016年排在前5位的分别是:科室8、科室2、科室23、科室5、科室4。经过3年的科室自身的发展,2019年排在前5位的是科室16、科室8、科室24、科室23、科室2。结论使用TOPSIS法综合评价26个临床科室疾病风险调整后指标,进行医疗服务的动态综合评价,结果符合医院实际情况,对提升医院精细化管理水平有实际意义。

Objective Through the construction of a risk-adjusted quality evaluation model,departments are evaluated from multiple dimensions such as medical quality,work efficiency,and cost control,so as to provide data support for the sustainable development of the hospital.Methods The DMIAES product tool of a company was used to calculate the disease risk adjusted case portfolio index value of each inpatient department,the total weight after risk adjustment,and the ratio of the actual value to the predicted value(mortality O/E value,hospitalization day O/E value,total cost(O/E value),using TOPSIS method to conduct dynamic comprehensive evaluation of 26 inpatient departments.Results From 2016 to 2019,the hospital's inpatient service situation improved year by year,the overall cost control was relatively stable,and the medical quality and medical efficiency were improved year by year.The contribution level of each department was different.The top 5 in 2016 were:Department 8 and Department 2,Section 23,Section 5,Section 4.After 3 years of development of the department itself,the top 5 in 2019 are Department 16,Department 8,Department 24,Department 23,and Department 2.Conclusion The TOPSIS method is used to comprehensively evaluate the disease risk adjusted indicators of 26 clinical departments and conduct a dynamic comprehensive evaluation of medical services.The results are in line with the actual situation of the hospital and have practical significance for improving the level of refined management of the hospital.