医疗服务指标的标准化：医院管理的有效手段。

Standardization of medical service indicators: A useful technique for hospital administration.

机构信息

Center of Clinical Evaluation, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.

Department of Information, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.

出版信息

PLoS One. 2018 Nov 28;13(11):e0207214. doi: 10.1371/journal.pone.0207214. eCollection 2018.

DOI:10.1371/journal.pone.0207214

PMID:30485302

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6261548/

Abstract

BACKGROUND

Many comparability problems appear in the process of the performance assessment of medical service. When comparing medical evaluation indicators across hospitals, or even within the same hospital, over time, the differences in the population composition such as types of diseases, comorbidities, demographic characteristics should be taken into account. This study aims to introduce a standardization technique for medical service indicators and provide a new insight on the comparability of medical data.

METHODS

The medical records of 142592 inpatient from three hospitals in 2017 were included in this study. Chi-square and Kruskal-Wallis tests were used to explore the compositions of confounding factors among populations. The procedure of stratified standardization technique was applied to compare the differences of the average length of stay and the average hospitalization expense among three hospitals.

RESULTS

Age, gender, comorbidity, and principal diagnoses category were considered as confounding factors. After correcting all factors, the average length of stay of hospital A and C were increased by 0.21 and 1.20 days, respectively, while that of hospital B was reduced by 1.54 days. The average hospitalization expenses of hospital A and C were increased by 1494 and 660 Yuan, whilst that of hospital B was decreased by 810 Yuan.

CONCLUSIONS

Standardization method will be helpful to improve the comparability of medical service indicators in hospital administration. It could be a practical technique and worthy of promotion.

摘要

背景

在医疗服务绩效评估过程中会出现许多可比性问题。在比较不同医院甚至同一医院不同时间的医疗评估指标时，应考虑疾病类型、合并症、人口统计学特征等人群构成的差异。本研究旨在介绍一种医疗服务指标的标准化技术，并为医疗数据的可比性提供新的见解。

方法

本研究纳入了三所医院 2017 年 142592 例住院患者的病历。使用卡方检验和克鲁斯卡尔-沃利斯检验来探索人群中混杂因素的构成。应用分层标准化技术程序来比较三所医院之间平均住院时间和平均住院费用的差异。

结果

年龄、性别、合并症和主要诊断类别被认为是混杂因素。校正所有因素后，医院 A 和 C 的平均住院时间分别增加了 0.21 和 1.20 天，而医院 B 的平均住院时间减少了 1.54 天。医院 A 和 C 的平均住院费用分别增加了 1494 元和 660 元，而医院 B 的平均住院费用减少了 810 元。