基于非同质病例复杂度的医疗服务绩效评价

Performance evaluation of health care services based on disease complexity

目的:探究考虑非同质疾病复杂度和非期望产出情况下的医疗服务绩效评价和全面排名。方法:诊断相关组(DRG)在住院急症护理中将资源消耗模式相似的患者划分为具有临床意义的类别,将其整合到DEA评价框架中,解决医疗服务非同质性问题。将非期望产出视为负数据,开发了一种改进的基于松弛的超效率测度模型,可以处理非正值数据,构建融合DRG和DEA的绩效评价框架。使用北京21所大型医院共254191病例作为研究案例。结果:DRG-DEA绩效评价框架不仅可以获得决策单元的综合效率得分和完整排名,还考虑了患者的医疗费用和住院时长,体现了以患者为中心。结论:DRG-DEA评价框架帮助管理人员如何提高医院效率,促进“以人民健康为中心”的医疗服务绩效评价研究。

Objective:To explore the performance evaluation and full ranking of health care services allowing for non-homogeneous disease complexity and undesired outputs.Methods:The diagnosis-related group (DRG) classifies patients with similar resource consumption patterns into clinically significant categories in inpatient acute care,which is integrated into a DEA framework to solve non-homogeneity issues of health care services.A modified slacks-based super-efficiency measure model is developed to deal with non-positive data,and then a performance evaluation framework is established to reconcile DRG and DEA.A total of 254,191 cases from 21 large hospitals in Beijing are studied.Results:The DRG-DEA performance evaluation framework proposed in this study cannot merely obtain the comprehensive efficiency scores and complete ranks but also considers the charges and time of health care,which reflects patient-centeredness.Conclusion:The DRG-DEA framework supports managers how to improve hospital efficiency and fosters the performance evaluation of health care services centering on people’s health.