按病种分类的疾病诊疗难度测度及应用研究  

Study on the measurement and application of diagnostic and treatment difficulty in disease categories

作　　者：段磊[1,2] 张翔 张研[1,2] DUAN Lei;ZHANG Xiang;ZHANG Yan(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 430030,China;Research Centre for Rural Health Service,Key Research Institute of Humanities&,Wuhan Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [2]湖北省人文社科重点研究基地农村健康服务研究中心,湖北武汉430030

出　　处：《中国卫生政策研究》2024年第2期17-22,共6页Chinese Journal of Health Policy

基　　金：国家自然科学基金面上项目(71974064)。

摘　　要：本研究首次界定了按病种分类的疾病诊疗难度的内涵,运用按病种的疾病发生概率、平均总费用与治愈好转率对病种诊疗难度系数进行测算。采用七县(市)区2017年新农合医保报销数据计算住院病种诊疗难度系数,并绘制“病例数—诊疗难度系数”分布图与拟合曲线,结果符合病种发生的实际状况。对其中两个样本县分别计算相同病种的诊疗难度系数,并进行配对资料秩和检验,计算结果不存在显著差异(P=0.73),提示该算法结果稳健,能够较好地描绘病种的发生与分布规律。测度结果能够用于明确医疗机构病种诊疗范围,刻画医疗服务供给与需求行为,但也存在较为依赖样本量、权重确定较为主观等问题。This study delineated the conceptual framework of Diagnostic and Treatment Difficulty(DTD)for disease categories for the first time and calculated the coefficient by utilizing disease occurrence probability,average total cost,and cure/improvement rate.The study employed the 2017 data from the New Rural Cooperative Medical Insurance in seven counties or districts to assess the DTD coefficient of inpatient disease categories.It also generated a distribution chart and fitted curve illustrating the relationship between the number of cases and DTD coefficient,in line with disease occurrence patterns.A paired sample Wilcoxon rank-sum test was performed on the DTD coefficient of the same disease categories calculated for two sample counties,yielding non-significant results(p=0.73).This suggests that the algorithm is robust and effectively portrays the occurrence and distribution patterns of disease categories.The measurement results can be utilized to define the scope of disease categories in healthcare institutions and characterize healthcare service supply and demand behavior.However,it s worth noting potential limitations,including a reliance on sample size and subjectivity in weight determination.

关 键 词：病种 诊疗难度 测算模型 效用评价 

分 类 号：R197[医药卫生—卫生事业管理]