北京市脑血管病住院患者医疗服务绩效评估研究

目的 对2010年度北京市二级及以上医院脑血管病住院患者的医疗服务绩效进行评估。方法 以北京市二级及以上医院出院患者病案首页信息常规报告系统中的脑血管病数据为基础，采用北京版诊断相关组（Beijing Diagnosis Related Groups，BJ-DRGs），对医疗服务绩效进行评估。结果 本研究涉及的122家医院中，各医院DRGs组数范围为1～16，中位数为5，病例组合指数范围为0.75～1.86，中位数为1.00；费用消耗指数中位数为1.07，54.92%的医院费用消耗指数＞1；时间消耗指数中位数为1.21，72.13%的医院时间消耗指数＞1；52.46%的医院的时间消耗指数和费用消耗指数均＞1。在低风险组和中低风险组，患者住院死亡率为0；在中高风险组，患者住院死亡率中位数为3.0%。结论 在脑血管病住院患者医疗服务中，需要采取有针对性的管理策略和措施，进一步优化配置医疗资源利用，降低费用消耗指数和时间消耗指数，提高医疗服务效率。

Evaluation of Medical Service Performance in Cerebrovascular Disease Inpatients in Beijing

Objective To evaluate the medical service performance in cerebrovascular disease inpatients from Level 2 to 3 hospitals in Beijing, 2010. Methods The data was obtained from the section of cerebrovascular disease in ＇The Database of Inpatient Record＇ administered by Beijing Public Health Information Center. Beijing Diagnosis Related Groups（BJ-DRGs） was used as the tool to evaluate the medical service performance. Results There were 122 hospitals in this study. Number of DRGs ranged from 1 to 16, and the median of DRGs was 5. The case-mix index ranged from 0.75 to 1.86 with a median of 1.00. The median was 1.07 for cost consuming index, and 1.21 for time consuming index. Of all the hospitals, 54.92% had a cost consuming index higher than 1, and 72.13% had a time consuming index higher than 1; 52.46% was higher than 1 on both cost and time consuming index. The in-hospital case- fatality was 0 in the low and mid-low risk group, and 3.0% at median in the mid-high risk group. Conclusions In the medical service of cerebrovascular disease, effective administrative strategy and measurements should be taken to optimize the medical resources utilization, and to decrease the time and cost consuming indices, therefore to improve medical service performance in Beijing.