基于灰色关联分析探索影响临床科室CMI因素的研究

Factors influencing CMI in clinical departments,determined through grey correlation analysis

目的 探索影响某三级医院2021年临床科室病例组合指数(CMI)的因素及其关联程度,并提出针对性建议,促进医院高质量发展。方法 调取某三级医院2021年1月1日—12月31日23 657份病案首页数据以及2021年医院信息系统统计报表,通过灰色关联分析方法,分析平均住院日(天)、平均住院费用(元)、住院总收入(元)、病床使用率(%)、病床周转次数(次)、出院病人数(人)、出院患者手术占比(%)和四级手术占比(%)8个指标与临床科室CMI值的关联程度,并进行关联度排序,找出与临床科室CMI值密切相关的影响因素。结果 8个指标与临床科室CMI值的关联都很紧密,关联度从高到低依次为平均住院日(0.916)、平均住院费用(0.907)、病床使用率(0.905)、病床周转次数(0.844)、住院总收入(0.833)、四级手术占比(0.819)、出院病人数(0.807)、出院患者手术占比(0.770)。除出院患者手术占比(%)外,其余指标与CMI值关联度均大于0.8,具有强相关性。结论平均住院日、平均住院费用和病床使用率的高低直接影响临床科室CMI值,需从多收治疑难危重症病种、提高病床使用效能、优化医疗资源配置方面进行改善,从而提高临床科室CMI值,促进医疗技术发展,提升医院精细化管理的水平。

Objective The Case Mix Index(CMI)value of the clinical department of a tertiary hospital in Fujian Province was selected,the factors influencing the CMI and their related degrees were explored,and targeted suggestions were proposed to promote the high⁃quality development of hospitals.Methods The study data comprised 23657 medical records from a tertiary hospital between January 1,and December 31,2021,and the statistical reports of the hospital information system in 2021.The grey correlation analysis method was used to analyze the correlation degree of eight indicators⁃average days of stay day,average hospitalization expense(yuan),total hospitalization income(yuan),bed utilization rate(%),bed turnover time(time),number of discharged patients(person),proportion of discharged patients undergoing surgery(%),and proportion of fourth⁃level surgery(%)⁃with the CMI value of clinical departments,and to rank the correlation degree.The influencing factors closely associated with the CMI value of clinical departments were identified.Results The eight indicators closely associated with the CMI value of clinical departments,and their correlation degree,from high to low,were as follows:average length of stay(0.916),average hospitalization cost(0.907),bed utilization rate(0.905),bed turnover time(0.844),total hospi⁃talization income(0.833),proportion of fourth⁃level surgery(0.819),number of discharged patients(0.807),and proportion of discharged patients undergoing surgery(0.770).Except for the proportion of discharged patients undergoing surgery(%),the correlation degree between the other indicators and the CMI value was strong,exceeding 0.8.Conclusion Average length of stay,average hospitalization cost,and bed utilization rate directly affect the CMI value of clinical departments.The CMI value of clinical departments must be improved by treating difficult and critical diseases,improving the efficiency of bed use,and optimizing the allocation of medical resources,to pro⁃mote the development of medical technology and improve the level of hospital fine management.