DRGs对新生儿住院死亡风险评估的调整研究  

Risk-adjusting effect of DRGs on neonatal mortality

作　　者：章莹[1] 李正梅[1] 徐金龙[1] 韩栋[1] 王思琪[1] 张哲军 魏凌云[1] 

机构地区：[1]广东省妇幼保健院,广东广州510010 [2]深圳市快易优科技有限公司,广东深圳518055

出　　处：《现代预防医学》2017年第13期2376-2380,共5页Modern Preventive Medicine

基　　金：广东省自然科学基金资助(项目编号:S2012010008269);广东省科技计划项目(项目编号:2014A040401042)

摘　　要：目的评价WI-DRGs对新生儿住院死亡风险评估模型的调整效果,初步探索DRGs在我国医疗质量管理中的应用。方法采用logistic AIC逐步回归方法,分别拟合纳入与不纳入WI-DRGs的模型,评估DRGs对模型预测能力的影响,比较指标使用新生儿标化死亡比(SMR)。结果新生儿住院死亡率为3.11‰,其中,外院转入新生儿组、住院超过40天的新生儿组、患儿体重≤1.25kg DRGs组的住院死亡率较高。纳入DRGs评估模型依据疾病诊疗复杂程度有效调整评估结果,与未纳入DRGs模型相比,医疗机构A的标化死亡比略有下降,为1.10,医疗机构B的标化死亡比略有上升,为0.71。结论 WI-DRGs是有效的死亡率风险调整工具,以此评估的新生儿住院死亡率可以更准确地体现医疗机构病种复杂性与专科诊疗水平。Objective To evaluate the adjusting effects of WI - DRGs on neonatal mortality, and to explore the applicability of DRGs in medical quality management in China. Methods We fitted two logistic models with and without DRGs to estimate the expected probability of death, and we compared the derived standard mortality ratio （SMR） to verify the hospitals＇performance. Results The overall neonatal mortality was 3.11‰. The neonatal mortality was higher in transferred patients, length - of - stay 〉140 days ,and DRGs （the weight ≤ 1.25kg）. The model with DRGs accurately estimated the expected mortality according to the complexity of the disease. Taking DRGs consideration, the SMR of hospital A was amended to 1.10, while that of hospital B was corrected to 0.71. Conclusions The WI - DRGs is a powerful adjustment tool for mortality. The revised expected mortality can accurately reflect the disease complexity and skills in speciality.

关 键 词：新生儿住院死亡率 医疗质量 DRGS 

分 类 号：R194[医药卫生—卫生事业管理]