综合医院综合效益评价的病例组合模型研究

目的建立一种考虑病人病例组合的医院综合效益评价模型,以控制传统评价模型中各医院救治病人疾病复杂程度不同所致的偏倚。方法各医院病人疾病复杂程度由根据信息理论计算的病例组合指数(CMI)进行测量。采用病例组合指数对综合效益传统评价模型中指标进行调整(标化)得到新的病例组合评价模型。分别采用传统评价模型与病例组合评价模型评价2003年南充地区9所综合医院综合效益,比较两种模型得到的各医院综合效益排序情况。评价主要步骤包括从投入和产出角度构建评价指标体系,采用层次分析法确定各评价指标权重,根据投入产出比构建综合评价指数。结果9所医院的CMI值不同,其中有6所医院的CMI<1,3所医院的CMI值>1。9所医院中有7所医院采用病例组合模型得到的综合效益位次与采用传统评价模型得到的一致,另2所医院采用病例组合模型得到的位次与传统评价模型得到的位次不同。结论相对于传统评价模型,病例组合评价模型考虑了医院病人疾病复杂程度的影响,得出的结论更为客观真实。

Case Mix Model to Evaluate Complex Performance of General Hospitals

Objective To establish a new model taking case mix into account to control bias resulted from clinical difference of patients in hospitals neglected by traditional models to evaluate general hospitals' performance.Methods Case mix index(CMI)of hospitals calculated by information theory was used to measure the clinical difference of patients in hospitals.A model named case mix evaluation model in the study was established by using CMI to adjust(standardize)some indexes in traditional model.To the 9 general hospitals of Nanchong region in 2003,traditional evaluation model and case mix evaluation models were adopted to evaluate their performance respectively and ranks of hospitals' performance resulted from which were compared subsequently.The process of evaluation mainly included selecting evaluation indexes from input and output aspects,calculating every index's weigh according to the Analytic Hierarchy Process(AHP),composing a complex index based on the ratio of input-output.Results 9 hospitals' CMI were different,six of which <1 and three of which >1.Among 9 hospitals,there were 7 hospitals whose ranks of performance based on case mix evaluation model were consistent with that on traditional model and there were 2 hospitals whose ranks of performance were inconsistent.Conclusion Based on case mix evaluation model taking into account the clinical difference of patients among hospitals,the results are more objective and reliable than that on traditional model in comparison of hospitals performance.