基于真实世界数据的医用耗材合理使用评价研究

Research on evaluation of rational use of medical consumables based on real-world data

目的:基于真实世界数据(RWD)开展医用耗材合理使用评价,为医院医用耗材精细化管理提供循证依据。方法:选取医院胸外科病区A、病区B和病区C的3个病区3198例住院手术患者病案首页数据和医院信息系统(HIS)就诊记录,筛选出7个重点手术种类(手术1~7)和13名手术医生(医生1~13),进行患者人均住院耗材费用与科室、手术种类、耗材品类和医生的相关性分析。结果:病区、医生间患者人均住院耗材费用存在差异,3个病区手术患者人均住院耗材费用最高与最低相差6000余元;同种手术不同病区和不同医生人均住院耗材费用病区B和病区C较高,手术1、手术2、手术3和手术4的不同医生人均住院耗材费用存在差异,其中有5名医生费用偏高。结论:基于RWD的医用耗材合理使用评价,能够根据临床实际,从“科室-手术-耗材”三层维度开展评价,将耗材使用评价层次落实到执行医生,真正实现医用耗材的精细化管理。

Objective:To evaluate the rational use of medical consumables based on real-world data,and to provide reference for refined management of medical consumables in hospitals.Methods:Data on the first page of medical records and treatment records in the hospital information system(HIS)of 3,198 surgical inpatients in 3 wards of the thoracic surgery department in the hospital(marked as ward area A,ward area B and ward area C)was selected,7 key types of surgery(labeled as surgery 1 to surgery 7)were screened out,doctors with less than 20 surgical cases were excluded,and finally 13 surgeons(marked as doctor 1 to doctor 13)were included in the analysis of the correlation between the cost of in-hospital consumables per patient and departments,types of surgeries,categories of consumables and doctors.Results:There were differences in the per capita hospitalization consumables cost for patients among different ward areas and doctors,with the difference between the highest and lowest per capita hospitalization consumables cost of around CNY 6,000.The per capita cost of hospitalization consumables in different ward areas and different doctors for the same type of surgery was higher in ward area B and ward area C.The per capita hospitalization consumables cost of different doctors of surgery 1,surgery 2,surgery 3 and surgery 4 were different and the cost of doctor 1,doctor 2,doctor 4,doctor 5 and doctor 9 were on the high side.Conclusion:The evaluation of the rational use of medical consumables based on real-world data can carry out the evaluation from the three dimensions of"department-surgery-consumables"according to the clinical practice,implement the evaluation level of consumables use to the executive doctor,and truly realize the refined management of medical consumables.