目的 探討基于疾病診斷相關(guān)分組(DRGs)的病例組合指數(shù)(CMI)在例均藥費(fèi)聯(lián)動(dòng)績效考核中的應(yīng)用價(jià)值。方法 提取2018年1月-2021年12月北京友誼醫(yī)院外科系統(tǒng)臨床科室每月的住院例均藥費(fèi)與CMI值。以CMI值為自變量、住院例均藥費(fèi)為因變量繪制散點(diǎn)圖,判斷并擬合二者間的相關(guān)關(guān)系。根據(jù)各科室CMI值年度變化情況對住院例均藥費(fèi)目標(biāo)值進(jìn)行聯(lián)動(dòng)調(diào)整,并比較各科室調(diào)整前后的績效綜合排名情況。結(jié)果 住院例均藥費(fèi)與CMI值呈正相關(guān),二者線性回歸的擬合度最好(R²為0.6891)。CMI值每增加0.1個(gè)單位,住院例均藥費(fèi)增加454元。采用經(jīng)CMI校正的聯(lián)動(dòng)考核方式較傳統(tǒng)目標(biāo)值考核方式得出的科室綜合排名出現(xiàn)了變化,新的考核方式能更為準(zhǔn)確地反映出各科室的合理用藥情況。結(jié)論 基于DRGs的CMI在臨床科室住院例均藥費(fèi)的考核中能夠與收治病例的復(fù)雜和嚴(yán)重程度相匹配,建議醫(yī)療機(jī)構(gòu)對住院例均藥費(fèi)與CMI實(shí)行聯(lián)動(dòng)績效考核。

Objective To explore the application value of case mix index (CMI) based on diagnosis related groups (DRGs) in the performance evaluation of average hospitalization drug expense in clinical department.Methods The monthly average hospitalization drug expenses and CMI values of surgical departments, which were acquired from Beijing Friendship Hospital, were respectively collected from January 2018 to December 2021. The scatter chart was drawn with CMI values and average hospitalization drug expenses, to evaluate and fit the correlation between them. The target value of average hospitalization drug expense was adjusted according to the annual change of CMI value of each clinical department, and then we compared the comprehensive ranking of performance evaluation of each department before and after adjustment.Results A positive correlation was observed between average hospitalization drug expense and CMI value. The R2 of linear regression was 0.689 1, which best described the fitting degree of regression. The average hospitalization drug expense should increase by 454 yuan when CMI value increases by 0.1 unit. After CMI value adjusted performance evaluation, the comprehensive ranking of clinical departments was changed in comparison with the traditional assessment method, indicating that the new assessment method can more accurately evaluate the rational drug use in cinical departments.Conclusion The CMI value based on DRGs can match with the complexity and severity of hospitalized cases in clinical departments, and it is suggested that medical institutions should carry out linkage performance assessment of average hospitalization drug expense and CMI.

R288.6

國家自然科學(xué)基金青年科學(xué)基金項(xiàng)目(82104310);北京醫(yī)衛(wèi)健康公益基金會(huì)醫(yī)學(xué)科學(xué)研究基金項(xiàng)目(B20199FN)