基于DRG的肿瘤专科医院死亡病例分析

Analysis of Death Cases in Oncology Hospitals Based on DRG

目的探讨基于疾病诊断相关分组(DRG)的死亡风险分级方法评价医疗质量,为医疗质量管理提供参考。方法运用北京市DRG工具对北京市某三级甲等肿瘤医院2015—2019年出院患者进行DRG分组,以死亡风险分级方法评价医院和科室的医疗质量,并与22家北京市市属医院肿瘤科进行比较。结果309906例患者中,共发生死亡470例(死亡率0.152%),死亡率呈现逐年下降趋势(χ^(2)=84.662,P<0.0001),其中,低风险死亡21例(死亡率0.017%),中低风险死亡41例(死亡率0.042%),中高风险死亡232例(死亡率0.781%),高风险死亡176例(死亡率1.526%),均低于22家北京市市属医院肿瘤科平均水平。科室N的低风险死亡率(0.201%)和中低风险死亡率(0.785%)相对较高,需注意医疗质量或病案首页质量。结论与粗死亡率指标相比,基于DRG的死亡风险分级评价医院医疗质量更加科学、合理。医院整体医疗质量相对较好,但要加强对低风险和中低风险死亡病例的监管,进一步规范病案首页的填写和编码工作。

Objective To explore the method of mortality risk classification for medical quality evaluation based on DRG,and to provide reference for medical quality management.Methods Using the Beijing disease diagnosis related grouping device to group the discharged cases information of a tertiary grade A cancer hospital in Beijing from2015 to 2019.The overall medical quality of the hospital was evaluated by the mortality risk classification method.The horizontal comparison between departments within the hospital was carried out,and compared with oncology departments of 22 municipal hospitals in Beijing.Results Among the 309906 discharged patients,470 patients died(mortality rate 0.152%),showing a decreasing trend year by year(χ^(2)=84.662,P<0.0001).There were 21 lowrisk deaths(mortality rate 0.017%),41 medium-low risk deaths(mortality rate 0.042%),232 medium-high risk deaths(mortality rate 0.781%)and 176 high-risk deaths(mortality rate 1.526%)occurred in the hospital,which were lower than the average level of oncology department of Beijing municipal hospitals,reflecting a good level of medical quality in the hospital.The low-risk mortality rate(0.201%)and medium-low risk mortality rate(0.785%)in the department N are relatively high,suggesting that the department should pay attention to the medical quality or the data quality on the first page of medical records.Conclusion Compared with the traditional crude mortality index,it is more scientific and reasonable to evaluate the quality of hospital medical care using death risk classification based on DRG.The overall medical quality of the hospital is relatively good,but it is necessary to strengthen the supervision on the low risk and medium-low risk death cases,further standardize the filling and coding of the first page of medical records.