目的 探讨基于疾病诊断相关分组(DRGs)的病例组合指数(CMI)在例均药费联动绩效考核中的应用价值。方法 提取2018年1月-2021年12月北京友谊医院外科系统临床科室每月的住院例均药费与CMI值。以CMI值为自变量、住院例均药费为因变量绘制散点图,判断并拟合二者间的相关关系。根据各科室CMI值年度变化情况对住院例均药费目标值进行联动调整,并比较各科室调整前后的绩效综合排名情况。结果 住院例均药费与CMI值呈正相关,二者线性回归的拟合度最好(R²为0.6891)。CMI值每增加0.1个单位,住院例均药费增加454元。采用经CMI校正的联动考核方式较传统目标值考核方式得出的科室综合排名出现了变化,新的考核方式能更为准确地反映出各科室的合理用药情况。结论 基于DRGs的CMI在临床科室住院例均药费的考核中能够与收治病例的复杂和严重程度相匹配,建议医疗机构对住院例均药费与CMI实行联动绩效考核。

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

国家自然科学基金青年科学基金项目(82104310);北京医卫健康公益基金会医学科学研究基金项目(B20199FN)