Risk adjustment and its application in refined hospital management and assessment / 中华医院管理杂志

ABSTRACT

Objective@#To study new ways and tools for assessing the inpatient disease management and improving refined management of the hospital.@*Methods@#By using homepages of medical records of the patients discharged from 21 tertiary general hospitals in a city in 2016, we completed the modeling and predicted value calculation within each DRGs with the Disease Management Intelligent Analytic & Evaluation System (DMIAES System).@*Results@#2 192 predication models were built, to compute the theoretic values of the mortality rate, length of stay, medical fee, medical service fee, and drug cost of each inpatient. Such values were compared with the observed results to gain the O/E index. If O/E is less than 1, it indicates that the inpatient′s disease management is good and better than expected. On the other hand, O/E index greater than 1 indicates poorer disease management than expected and rooms of further improvement. With the help of O/E index, we made multidimensional comparisons assessment and analysis of different hospitals, clinical disciplines, diseases and doctors.@*Conclusions@#The DMIAES System can take risk factors of inpatients′ outcomes into account, assessing the major indicators of inpatient outcomes by means of big data and modelling. This approach proves effective in enabling administrators and doctors to rapidly analyze problems for identifying solutions and enhancing management, thus having great potential in hospital management, supervision and assessment.