基于DRG的VLAD法在医疗质量管理中应用研究  

Application Research on Variable Life Adjusted Display in Hospital Medical Quality Based on DRG

作　　者：杜圣普[1] 卢铭 金昌晓[1] DU Sheng-pu;LU Ming;JIN Chang-xiao(Peking University Third Hospital,Beijing,100191,China)

机构地区：[1]北京大学第三医院,北京100191

出　　处：《中国医院管理》2020年第8期40-42,共3页Chinese Hospital Management

基　　金：北京大学医学部“985工程”二期建设项目(985205939)。

摘　　要：目的 在常规医疗质量监测的基础上,研究一种基于疾病风险因素且能够及时反映医疗质量结果的精细化监测方法.方法 VLAD法既能够反映实际死亡率与预期死亡率之间的差别,也可以反映医院、医师和病组诊疗水平结果的优劣和变化趋势,预期死亡率来源于DRG组的死亡率.根据每个病例的生存状态和预期死亡率,评分系统对病例进行评分.结果 常规医疗质量监测和VLAD法分别对同一位医师的1212位患者诊治结果的统计情况进行分析发现,VLAD法能够对医师的诊疗结果进行监测并及时反馈,从而提示医师诊疗技术差距.通过对同一DRG组的89个病例的诊疗结果分析,常规医疗质量监测容易掩盖诊疗过程中存在的问题,而VLAD能够提示存在缺陷的病例.结论 采用VLAD法既能够展示基于疾病风险因素的医疗质量结果,也能够对医师在一定范围内的诊疗结果进行实时监测,有利于提高医院整体医疗质量.Objective On the basis of regular medical quality supervision,to study a refinement supervision method of medical quality results based on disease risk factors.Methods The variable life adjusted display(VLAD)plot shows the difference between expected and actual cumulative mortality.VLAD shows whether a hospital’s or surgeon’s performance is above or below what could be expected.The mortality scoring system accumulates penalties for every death and rewards for each survivor,based on the patient severity which is derived from DRG mortality.Results Through routine medical quality supervision and VLAD,the results of 1212 patients who were treated showed that VLAD could monitor and timely feedback the diagnosis and treatment results,and hinted physician’s diagnosis and treatment technique gaps.Through the analysis of diagnosis and treatment results of 89 medical records,routine medical quality supervision is easily to cover up the problems during diagnosis and treatment process,while VLAD could hint the deficiency cases.Conclusion VLAD based on diagnosis related groups can not only reveals a graphical display of risk adjusted survival for individual surgeons and may monitor performance over a range of treatments and outcomes,so as to improve the overall medical quality of the hospital.

关 键 词：疾病诊断相关分组VLAD法 医疗质量 

分 类 号：R197.323.4[医药卫生—卫生事业管理]