疾病风险调整方法在病种精细化评价中的应用

Application of Disease Risk Adjustment Method in Fine Evaluation of Disease Groups

目的应用疾病风险调整方法,实现对各专科病种平均住院天数、次均费用等指标的合理预测,为病种管理提供依据。方法应用疾病风险调整方法对某三甲综合医院2016年-2019年住院患者出院病案首页信息进行挖掘,围绕O/E指数、AW、ACMI和ACMP等主要监测指标展开分析。结果通过疾病风险调整,ACMI、ACMP更加合理地展现了服务难度,应用O/E值实现了分时间、分科室、分病种设置指标合理目标值,同时解决了各科室、病种间监测指标的横向比较问题。结论疾病风险调整方法能够更加真实、客观地评价临床服务能力、服务效率及技术水平,但其有效程度取决于历史数据的真实性、完整性和准确性。

Objective To use the disease risk adjustment method to reasonable predict the average length of stay and the average cost per time of each disease in the hospital,so as to provide evidence for disease management.Methods The disease risk adjustment method was used to analyze the medical record homepage in a tertiary general hospital from 2016to 2019.The main monitoring indicators,including O/E index,AW,ACMI and ACMP,were analyzed.Results Through the disease risk adjustment,ACMI and ACMP reflected the service difficulty more reasonably.The application of O/E index realized the reasonable target value of indicators set by time,department and disease,and solved the horizontal comparability of monitoring indicators among departments and disease types.Furthermore,the problem of horizontal comparability of monitoring indicators among departments and diseases was solved.Conclusion The disease risk adjustment method can more truly and objectively evaluate clinical service ability,service efficiency and technical level,but the effectiveness depends on the authenticity,completeness and accuracy of historical data.