基于超效率DEA-Malmquist指数模型的多院区公立医院肿瘤科运行效率评价

Evaluation of the operational efficiency of oncology department in a multi-campus public hospital based on the super efficiency DEA-Malmquist index model

目的分析多院区医院肿瘤科的运行效率,为科室合理配置资源,提升效率提供参考。方法某三级甲等医院为实行一体化管理的多院区公立医院,本研究以其肿瘤科为研究对象,将该科位于不同院区的9个病区作为决策单元。自医院的病案管理系统、疾病诊断相关分组管理系统和医院信息系统中提取肿瘤科2020—2022年的相关数据,运用超效率数据包络分析(DEA)及Malmquist指数模型评价肿瘤科在不同时间段和不同决策单元的效率变化情况,并通过投影值分析识别未达到规模报酬固定病区的投入冗余率和产出不足率。选取医务人员总数和实际占用总床日数为投入指标,病床使用率、出院人次和病例组合指数为产出指标。结果2020—2022年肿瘤科超效率值>1的病区分别有0、2、4个,总体效率逐步增高。2022年,S3、S4、S7和S9病区的超效率值分别为1.001、1.005、1.113和1.112,均达到规模报酬固定;其他5个病区的投入冗余率均为0,但存在产出不足,其中S5和S8病区的病床使用率应在现有基础上分别提高5%和4%,S1和S8病区的年出院人次应分别增加24%和1%,S2和S6病区的年度病例组合指数应分别增加21%和20%。2020—2021年,肿瘤科的Malmquist指数为0.959,2021—2022年则升至1.030,且各病区的Malmquist指数均>1。结论通过实施多院区一体化管理,肿瘤科的运行效率得到了全面提升。采用超效率DEA-Malmquist指数模型评价科室运行效率具有实践意义。

Objective To analyze the operational efficiency of the oncology department in multi-campus hospital,providing reference for rational resource allocation and efficiency enhancement.Methods A certaion tertiary grade A Hospital is a multi-campus public hospital with integrated management.This study focused on its oncology department,with 9 wards located in different campus as decision-making units.Data from 2020 to 2022 were extracted from the hospital′s medical records management system,disease diagnosis-related groups management system,and hospital information system.The super-efficiency DEA model and Malmquist index model were used to evaluate efficiency variations of the oncology department in different time slots and decision-making units.Identifying input redundancies and output deficiencies in wards not achieving constant returns to scale through projection value analysis.Selecting the total number of medical staff and the actual total number of bed-days occupied as input indicators,while bed utilization rate,discharge rate,and case mix index as output indicators.Results From 2020 to 2022,the wards with a DEA super-efficiency value greater than 1 were 0,2,and 4,respectively,showing a gradual increase in overall efficiency.In 2022,wards S3,S4,S7,and S9 achieved constant returns to scale with super-efficiency values of 1.001,1.005,1.113,and 1.112,respectively.The other five wards had zero input redundancy,but some suffered from insufficient outputs.For example,wards S5 and S8 should increase their bed utilization rates by 5% and 4%,respectively.Wards S1 and S8 needed to increase their annual discharge numbers by 24% and 1%,respectively,while wards S2 and S6 should increase their annual case mix index by 21% and 20%,respectively.From 2020 to 2021,the Malmquist index of the oncology department was 0.959,while from 2021 to 2022 it rose to 1.030,and the Malmquist index of each ward was greater than 1.Conclusions By implementing integrated management across multiple campus,the operational efficiency of the oncology department has been comprehensively improved.The use of the super efficient DEA-Malmquist index model to evaluate the operational efficiency of departments has practical significance.