循环系统病例死亡风险分级研究

目的探讨病例死亡风险分级方法,为提高医院综合诊治和管理水平提供方向,为医疗质量评价提供参考。方法以9008例循环系统住院病例为例,以主诊断转归为目标变量,应用卡方自动交互作用检测法CHAID进行分组,并对急性心肌梗死组分年度进行初步评价。结果样本共计分为35个不同死亡风险的组,归入零风险组、超低风险组、低风险组、高风险组和超高风险组五级。其中急性心肌梗死组,低风险组和超高风险组各年度死亡率不同,说明利用零风险组、超低风险组和低风险组患者群死亡率进行基础医疗质量评价更为合理和敏感,而利用高风险组和超高风险组患者群死亡率可进行医院危重救治能力和综合管理水平方面的评价。结论可将病例进行死亡风险分级,并用于科间、院间或不同时段医疗质量评价。

Investigation on Mortality Risk Classification of Circulatory System Cases

Objective To investigate the methods of mortality risk classification in order to determine direction for comprehensive regulation and management of hospital and provide reference for evaluation of medical quality.Methods Taking circulatory system cases for instance,and with principal diagnosis as objective variable,initial evaluation was done on cases with acute myocardial infarction annually grouped by CHAID（chi-square automatic interaction detection）.Results Samples are divided into 35 groups with different mortality risk,included into zero risk groups,super-low risk groups,low-risk groups,high-risk groups and super-high risk groups,respectively. For acute myocardial infarction groups,different mortality was found in low-risk group and super-high risk group among each year,so it is more reasonable and sensitive to evaluate basic medical quality with mortality in zero risk groups,super-low risk groups and low-risk groups,meanwhile,the treatment of critical illness and comprehensive management for hospital were evaluated through mortality in high-risk groups and super-high risk groups.Conclusion Mortality risk classification was conducted,which can be used for quality evaluation between different departments,hospitals and phases.