【摘 要】
：
目的:探讨疾病诊断相关分组（DRGs）指标在选择以及计算中应注意的问题，为有关部门提供参考。方法:以中山大学附属第七医院（深圳）2019年8月至12月病案首页资料作为基础数据，采用DRGs分组器对病例进行分组，并计算总权重、病例组合指数（CMI）、DRGs组数、费用消耗指数、时间消耗指数、低风险病死率、床均权重、医师工作负荷、总手术难度共9个指标。结果:除低风险病死率以外，其余8个DRGs评价指标在不同科室间均有较大差异。不同科室间的床均权重存在较大差异，最高可达2倍以上。科室的床均权重和校正后的总权重相
【机 构】
：
中山大学附属第七医院（深圳）质量管理评价处 518107;中山大学附属第七医院（深圳）人力资源管理处 518107
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目的:探讨疾病诊断相关分组（DRGs）指标在选择以及计算中应注意的问题，为有关部门提供参考。方法:以中山大学附属第七医院（深圳）2019年8月至12月病案首页资料作为基础数据，采用DRGs分组器对病例进行分组，并计算总权重、病例组合指数（CMI）、DRGs组数、费用消耗指数、时间消耗指数、低风险病死率、床均权重、医师工作负荷、总手术难度共9个指标。结果:除低风险病死率以外，其余8个DRGs评价指标在不同科室间均有较大差异。不同科室间的床均权重存在较大差异，最高可达2倍以上。科室的床均权重和校正后的总权重相关系数仅为0.015，可认为两者间不存在相关关系。而将不入组病例计入总权重（n P＜0.001），这说明不入组病例的权重会对总权重产生显著影响，而转科因素仅会对个别科室的总权重产生显著影响。不同科室的医师工作负荷存在显著差异，其中，外科的理论人均权重上限在170～275，要显著高于内科120～169。不同科室的总手术难度存在较大差异，且采用不同的方法计算总手术难度，会对分析结果产生影响。n 结论:医院管理部门应从实际工作需要出发，结合医院发展导向选择考核指标，同时，可对DRGs评价指标的计算方法进行灵活调整。在进行科室间评价时，应注意指标的公平性与合理性。“,”Objective:To discuss the selection, calculation, and practical application of diagnosis related groups (DRGs) and provide reference for relevant departments.Methods:Based on the homepage data of medical records of The Seventh Affiliated Hospital of Sun Yat-sen University from August to December 2019, the DRGs grouping device was used to group the cases, and 9 indexes [total weight, case-mix index (CMI), number of DRGs groups, cost consumption index, time consumption index, low-risk mortality, average sickbed weight, physician workload, and total operation difficulty] were calculated.Results:Except for the low-risk mortality, there were significant differences in the other 8 DRGs indexes among different departments. There was a great difference in the average sickbed weight among different departments, up to more than 2 times. The correlation coefficient between the average sickbed weight and corrected total weight of departments was only 0.015, so it could be considered that there was no correlation between them. If the non-enrolled-cases were calculated in the total weight (n P<0.001), there would have a significant impact on the total weight, while the department-transfer factor would only have a significant impact on the total weight of individual departments. There were significant differences in the workload of doctors in different departments, among which the upper limit of theoretical weight per capita in the surgery was 170-275, significantly higher than that in the internal medicine (120-169). There were great differences in the total operation difficulty in different departments, and different methods to calculate the total operation difficulty would affect the analysis results.n Conclusions:The hospital management department should start from the actual work needs and combine with the development orientation of the hospital to select the evaluation indexes. At the same time, the calculation method of DRGs evaluation indexes can be adjusted flexibly. When evaluating between departments, we should pay attention to the fairness and rationality of the indexes.
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