病例组合指数在诊疗行为差异性评价中的应用探讨

摘要

Objective The Case Mix Index (CMI) was used to analyze the treatment and cost differences of different doctors for different annual changes in patients with a disease,and to evaluate the treatment behavior and outcome of the doctors.Methods Selecting the information of the home page of patients with pulmonary malignant tumor disease (ICD-C34) in a tertiary hospital,and to extract the CMI value of the patients' disease diagnosis.Analyzing the differences of the cost and hospitalization time of different doctors in the treatment of the dise,ase,and analyzing the changes according to the annual analysis.Results There is no significant difference in CMI of the patients (P＞0.05).There is significant difference among the treatment costs of different doctors for the treatment of the disease (P＜0.05).The results of logistic analysis,of which hospitalization cost is as the dependent variable;and CMI,age,surgical method and the doctor,as independent variables,show that CMI has influence on hospitalization expense.The difference in the cost of a doctors' treatment may be related with the choice of the procedure and surgery level.Conclusion Different doctors differ in the treatment of the same disease,and the use of CMI is of guiding significance to the evaluation of doctors' diagnosis and treatment and the control of medical expenses.%目的 运用病例组合指数(CMI)分析不同医生对某一疾病患者的不同年度变化治疗方式及费用差异,指导评估医生的治疗行为和结局.方法 选取某三级甲等综合医院胸外科肺恶性肿瘤疾病患者(ICD-C34)住院病例的住院首页信息,提取患者疾病诊断的CMI.分析不同医生治疗该类患者的费用,住院时间等治疗相关情况的差异,并按年度分析其变化情况.结果 各位医生诊治患者的CMI差异无统计学意义(P＞0.05).不同医生的对该疾病的治疗费用差异有统计学意义(P＜0.05),以住院费用为因变量,CMI、年龄、术式以及医生等为自变量的logistic分析结果表明,CMI对住院费用具有影响.医生治疗费用的差异可能与其选择的术式及手术水平相关.结论 不同医生对同一疾病的治疗情况存在差异,采用CMI对医生诊疗行为的评估和医疗费用的控制都具有指导意义.