Díez A, Tomás R, Varela J, Casas M, González-Macías J
Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Universitario del Mar, Barcelona.
Med Clin (Barc). 1996 Mar 16;106(10):361-7.
To analyze the case-mix and efficiency in a group of Services of Internal Medicine (IM) from 52 Spanish hospitals with routinary clinical information system.
From a total amount of 566,726 discharges during 1992, we studied the 71,430 corresponding to IM, analyzing the Minimum Basic Data Set and the Diagnosis-Related Groups (DRG). The hospitals were classified as level A (< 250 beds), B (251-599) and C (600 or over). We analyzed: Major Diagnostic Category (MDC); DRG, raw average length of stay (ALOS); outliers, trimmed ALOS; mortality; case-mix index; performance index; ajusted ALOS (by standard performance and case-mix); associated complications; number of diagnoses per discharge. A Chi-square test was used for qualitative variables and a mean-comparison test (independent data) for the quantitative ones.
Among the Internal Medicine Departments, IM was the Service that cared most patients, even more in the small-size hospitals. The most frequent DRG were: chronic obstructive pulmonary disease (COPD) 6.5% (DRG 088); simple pneumonia & pleuresy 6.1% (DRGs 089-090); heart failure 5.9% (DRG 127); stroke 4.5% (DRG 014); and angor pectoris 2.4% (DRG 140). The ALOS was shorter in the A-level hospitals (10.1 days) vs. B-level (11.6) and C-level (14.4). However, the trimmed ALOS was more homogeneous (A 8.8; B 9.9; C 11.7). The complexity indexes increased with the hospital level although the performance index also increased.
The IM services provide care for a high percentage of hospital patients, especially in the small-size centers. In these, less complex patients are seen, with decreased comorbidity, complications and mortality and they solve their patients with shorter ALOS than the IM services in the large-size hospitals.
分析52家拥有常规临床信息系统的西班牙医院内科服务的病例组合和效率。
在1992年总计566,726例出院病例中，我们研究了与内科相关的71,430例病例，分析了最低基本数据集和诊断相关分组（DRG）。医院被分为A类（床位<250张）、B类（251 - 599张）和C类（600张及以上）。我们分析了：主要诊断类别（MDC）；DRG、原始平均住院日（ALOS）；异常值、调整后的ALOS；死亡率；病例组合指数；绩效指数；调整后的ALOS（按标准绩效和病例组合）；相关并发症；每次出院的诊断数量。定性变量采用卡方检验，定量变量采用均值比较检验（独立数据）。
在内科部门中，内科是照顾患者最多的科室，在小型医院中更是如此。最常见的DRG为：慢性阻塞性肺疾病（COPD）6.5%（DRG 088）；单纯性肺炎和胸膜炎6.1%（DRGs 089 - 090）；心力衰竭5.9%（DRG 127）；中风4.5%（DRG 014）；心绞痛2.4%（DRG 140）。A类医院的ALOS（10.1天）比B类医院（11.6天）和C类医院（14.4天）短。然而，调整后的ALOS更具同质性（A类8.8天；B类9.9天；C类11.7天）。尽管绩效指数也有所增加，但复杂性指数随着医院级别升高而增加。
内科服务为很大比例的住院患者提供护理，尤其是在小型中心。在这些小型中心，所诊治的患者病情不太复杂，合并症、并发症和死亡率较低，且与大型医院的内科服务相比，患者住院时间更短。
