基于DRGs的TOPSIS与RSR模糊联合法在结核科住院医疗服务绩效评价的探索

Evaluation of Medical Service Performance of Tuberculosis Department by TOPSIS and RSR Fuzzy Combination Methods based on DRGs

目的 通过应用DRG相关指标,对某结核病专科医院的住院医疗服务绩效进行评价,为医院相关专业技术优化提供建议。方法 以CN-DRG分组方案为工具,以医院8个结核专科科室2018-2020年39 842份病案首页数据为基础,选取能反映医疗服务能力、医疗服务效率、医疗质量安全的3个维度9个DRG指标,运用TOPSIS和RSR模糊联合法对各结核专科DRG组数、CMI、时间/费用消耗指数、低风险死亡率等指标进行分析。结果 TOPSIS法评价结果显示,前两位为结核-呼吸Ⅱ科、结核Ⅳ科,C_(i)分别为0.584 3和0.562 9,最末位为结核-ICU,C_(i)为0.399 8,RSR法评价结果显示,前两位为结核-呼吸Ⅱ科、结核Ⅲ科,RSR值分别为0.644 2和0.634 6,最末位为结核-ICU,RSR值为0.418 3,模糊联合方法评价结果显示,前两位为结核-呼吸Ⅱ科、结核Ⅲ科,最末位为结核-ICU。结论 3种评价方法结果不完全相同,但趋势较为一致。运用TOPSIS与RSR模糊联合法在结核科住院医疗服务绩效评价应用,能弥补单一评价方法的局限,实现各结核专科科室疾病难度、技术水平、收治病种范围、资源消耗等的同质化比较,为医院结核专科强化优势、弥补短板提供数据依据及发展方向。

Objective To evaluate the inpatient medical service performance of tuberculosis specialists in a tertiary hospital based on Diagnostic Related Groups(DRGs)indicators,to provide suggestions for the optimization of related professional technology of the hospital.Methods Using CN-DRG grouping scheme as a tool,the data of 39 842 medical records was collected from 2018 to 2020 in eight tuberculosis departments in the hospital.9 DRG indicators in 3 dimensions that can reflect medical service capacity,medical service efficiency and medical quality and safety were selected.TOPSIS and RSR fuzzy combined method was used to analyze the number of DRG groups,CMI,time/cost consumption index,low-risk mortality and other indicators in each tuberculosis specialty.Results The top two of the TOPSIS evaluation results were tuberculosis-respiratory Ⅱ and tuberculosis Ⅳ,with Ci of 0.584 3 and 0.562 9,respectively,and the last was tuberculosis-ICU,with Ci of 0.399 8.The top two of the results of the RSR method evaluation were tuberculosis-respiratory Ⅱ and tuberculosis Ⅲ,with RSR values of 0.644 2 and 0.634 6,respectively,and the last one was tuberculosis-ICU,with an RSR value of 0.418 3.The top two of the fuzzy combined method evaluation results were tuberculosis-respiratory department Ⅱ,tuberculosis department Ⅲ,and the last was tuberculosis-ICU.Conclusion The results of the three evaluation methods are not exactly the same,but the trend is relatively consistent.The application of TOPSIS and RSR fuzzy combination method in the performance evaluation of tuberculosis inpatient medical service can make up for the limitations of a single evaluation method,can realize the homogeneous comparison of disease difficulty,technical level,range of diseases admitted and resource consumption of each tuberculosis department,and strengthen the advantages of hospital tuberculosis department,make up for shortco-mings and provide data basis and development direction.