李顺飞　刘阳　曹秀堂

[摘要] 目的 对比分析病例组合指数（CMI）在不同地区、不同类型的大型综合医院临床医疗服务绩效评价中的适用性及其调整方法。 方法 分别以主要诊断类别（MDC）的病例构成、医院所在地区医疗服务空间价格指数（SPI）对样本医院CMI进行单独和联合标化调整，并结合卫生机关医院管理人员的感性评价，对CMI及其调整结果进行对比分析。 结果 教学医院较其他类型医院的诊疗范围更广、临床产出更高，各医院病组数、MDC构成及CMI值都存在一定差异。基于MDC构成的CMI标化可降低各医院收治疾病结构不同对CMI值的影响，通过MDC构成与SPI联合调整的医院顺位与感性评价结果更为接近。 结论 经标化调整的CMI值能更客观地反映不同地域、不同类型大型综合医院临床诊疗服务技术水平，为跨地域的医院临床绩效对比提供支撑。

[关键词] 医院绩效评价；病例组合指数；病种构成；空间价格指数

[中图分类号] R197.3 [文献标识码] A [文章编号] 1673-7210（2017）01（c）-0068-05

[Abstract] Objective To analyze the applicability and adjustment method of case mix index （CMI） in clinical performance evaluation of general hospitals with different types and in different regions. Methods The composition of MDC and the SPI of medical service were used to standardize separately and jointly the CMI values of sample hospitals. The perceptual evaluation of hospital management personnel was taken into consideration to compare the original and adjusted CMI values. Results Compared with other types of hospitals， teaching hospitals had a wider range of medical treatment and higher clinical output. There was differences in disease groups， MDC composition and CMI of different hospitals. The standardized CMI based on MDC reduced the impact of different disease compositions on CMI. The adjusted hospital ranking based on MDC and SPI was closer to the one based on perceptual evaluation. Conclusion The standardized CMI value can more objectively reflect the technical level of clinical diagnosis and treatment of general hospitals with different types and in different regions， and provide support for clinical performance comparison in different hospitals across regions.

[Key words] Hospital performance evaluation； Case mix index； Disease composition； Spatial price index

医院临床服务绩效的科学评价需要综合考虑患者疾病类型、治疗方式、医疗服务价格及医院等级与类型等诸多因素。从临床诊疗服务的固有特点来看，只有在评价时进行系统、科學的风险调整才能保障评价结果的可靠性[1]。在众多风险调整工具中，疾病诊断相关组（diagnosis related groups，DRGs）是国内外公认的兼顾临床诊疗过程与医疗资源消耗同质性的重要工具[2-3]。病例组合指数（case mix index，CMI）由平均医疗消耗相对水平得出的各DRGs权重值进行加权平均获得，用于评估医疗机构收治病例的复杂程度与治疗的技术难度水平[4]。……