病例组合指数的内涵及应用探讨

国内普遍认为病例组合指数(CMI)属于医疗服务能力维度，体现收治疾病的疑难复杂程度和医疗服务的整体技术难度。通过结构方程模型分析发现，CMI与时间消耗指数、费用消耗指数等服务效率维度指标联系更紧密，与DRG组数、入组病例数及总权重等服务能力维度指标联系相对较弱，故应归属医疗服务效率维度。CMI的直接应用主要是对平均住院费用的预测控制及对科室绩效的评价；CMI的间接应用主要是对管理指标的调整/校正。医院管理者应准确把握CMI内涵，恰当应用CMI对不同层级及不同类别住院费用进行预测、评价与控制，并对其他管理指标进行调整后再评价。

The Connotation and Application of the Case Combination Index

It is generally recognized in China that Case Mix Index (CMI) belongs to the dimension of medical service ability, which reflects the difficulty and complexity of diseases and the overall technical difficulty of medical service. The results of structural equation model showed that CMI was more closely related to service efficiency indicators such as time consumption index and cost consumption index, but less related to service capacity indicators such as number of Diagnosis Related Groups (DRGs), number of admitted cases and total DRGs weight; and CMI should be attributed to the dimension of medical service efficiency. The direct application of CMI was mainly the predication control of average hospitalization cost and the evaluation of department performance, and the indirect application of CMI was mainly the adjustment/correction of management indicators. Hospital managers should accurately grasp the connotation of CMI, properly use CMI to predict, evaluate and control hospitalization expenses at different levels and different categories, and adjust other management indicators before evaluation.