• 1. 解放軍總醫(yī)院醫(yī)療質(zhì)量管理研究科,北京,1008532. 四川大學(xué)華西醫(yī)院,中國循證醫(yī)學(xué)中心,成都,6100413. 解放軍小湯山醫(yī)院,北京,102211;

目的 　探索和建立一種適用于臨床與科學(xué)研究的SARS確診病例的計算機分型方法.
方法 ?、俜治霾“甘醉撟兞颗c患者病情的相關(guān)性,采用逐步判別分析,確定與病情相關(guān)的變量,構(gòu)建函數(shù)判別方程,建立病例分型計算機模型;②對比分析計算機分型與臨床分型的患者基本情況、臨床表現(xiàn)、實驗室結(jié)果、預(yù)后、住院天數(shù)、醫(yī)療費用等情況.
結(jié)果 ?、倥R床分型:本組680例中,普通型642例(94.41%),重癥型38例(5.59%);計算機分型:A型436例(64.12%),C型237例(34.85%),D型7例(1.03%),無B型病例.②臨床分型與計算機分型比較,其各組患者之間的一般情況(年齡、治愈率、死亡率和平均住院日)、實驗室部分指標(biāo)(總蛋白、白蛋白和尿素氮)與醫(yī)療費用均有統(tǒng)計學(xué)差異.③兩種分型方法對照分析:在計算機分型為A型(一般普通型)的患者中,99.77%為臨床分型的普通型;在臨床分型為重癥型的患者中,97.36%為計算機分型的CD型.
結(jié)論 　計算機分型與臨床分型方法之間有較好同源性,其絕大多數(shù)指標(biāo)的組間差異基本相似;兩種分型方法在普通型與危重型的結(jié)果有統(tǒng)計學(xué)上的差異,計算機分型中危重型患者的例數(shù)比臨床分型高6.42倍,與臨床分型比較,計算機分型的各組間有差異大、且危重型病例數(shù)多、組內(nèi)差異小、客觀性好和邏輯性強的優(yōu)勢,適用于醫(yī)療質(zhì)量管理、衛(wèi)生經(jīng)濟(jì)管理及藥物經(jīng)濟(jì)學(xué)等方面的研究與應(yīng)用.

引用本文： 董軍,曹秀堂,劉志敏,許紅民,李幼平,孫鑫,王莉,周亞春. 小湯山醫(yī)院680例SARS臨床確診病例的計算機分型研究. 中國循證醫(yī)學(xué)雜志, 2004, 04(5): 325-332. doi: 復(fù)制

1. ［1］Zhu SJ, Dong J. Chief-editor. Hospital administration and information utilizing[ M ]. Beijing: People’ s Military Publisher,2000: 57 - 59.
2. 朱士俊,董軍主編.醫(yī)院管理與信息利用[M].北京:人民軍醫(yī)出版社,2000:57～59.
3. ［2］Fu Z, Ren LZ. Hospital information system construction and application. Beijing: People’ s Military Publisher, 2002.
4. 傅征,任連仲.醫(yī)院信息系統(tǒng)建設(shè)與應(yīng)用[M].北京:人民軍醫(yī)出版社,2002.
5. ［3］Dong J, Liu ZM, Cao XT, Li YP, Sun Xin, Zhou YC, Zhang YL,Xie LX, Xu WY, Wang HT, Xu HM. Construction of SARS Information System in Xiao Tang Shan Hospital [ J ].Chinese Journal of Evidence-Based Medicine. 2004; 4 ( 3 ): 181- 186.
6. 董軍,劉志敏,曹秀堂,李幼平,孫鑫,周亞春,張雁靈,解立新,徐武夷,王海濤,許紅民.小湯山醫(yī)院SARS診療信息數(shù)據(jù)庫建設(shè)[J].中國循證醫(yī)學(xué)雜志,2004;4(3):181～186.
7. ［4］Dong J, Cao XT, Sun X, Zhou YC, Chen HW,Yuan ZJ,Liu ZM,Wang HT,Xu HM. Medical expenditure and influential factor analysis of 680 SARS cases[J]. Chinese Journal of Evidence-Based Medicine, 2003; 3(3):222-230.
8. 董軍,曹秀堂,孫鑫,周亞春,陳杭薇,袁志軍,劉志敏,王海濤,許紅民.680例SAKS臨床確診患者醫(yī)療費用和影響因素分析[J].中國循證醫(yī)學(xué)雜志,2003,3(3):222～230.
9. ［5］Zhang L, Dong J. The principle and methodology of case by classification [ J ]. Hospital Administration Journal of Chinese People’ s Liberation Army, 2000 ;7 (2): 101 - 103張力,董軍.病例分型的原則與方法[J].解放軍醫(yī)院管理雜志,2000;7(2):101～103.
10. ［6］Zhang L, Wang WZ. Characteristics and technical points of case by classification[J]. Chinese Journal of Hospital Administration, 2000; 16 (7) :392 - 393.
11. 張力,王文中.病例分型的特點和技術(shù)要點[J].中華醫(yī)院管理雜志,2000;16(7):392～393.
12. ［7］Zhang L, Dong J. Application of case by classification in the evaluation of case quality [J ]. Chinese Journal of Hospital Administration,2000; 16 (7): 394 - 398.
13. 張力,董軍.病例分型在病例質(zhì)量評價中的應(yīng)用[J].中華醫(yī)院管理雜志,2000;16(7):394～398.
14. ［8］Zhang L, Dong J. Difficulty and countermeasure of case by classificafion[J ]. Chinese Journal of Hospital Administration,2000; 16(7) :408.
15. 張力,董軍.病例分型的難點和對策[J].中華醫(yī)院管理雜志,2000;16(7):408.
16. ［9］Hugh SA, Leonie M. Casemix for all[ M ]. Redcliffe Medical Press, 1999. 5 - 16.
17. ［10］Forgione DA, D’ Annunzio CM. The use of DRGs in health care payment systems around the world[J ], J health Care Finance ,1999; 26:66 -78.
18. ［11］Huang HY. Development of DRGs in U. S. A[J]. Chinese Journal of Hospital Administration, 1992 ;7(8): 433.
19. 黃慧英.診斷相關(guān)分類法DRGs在美國的發(fā)展[J].中華醫(yī)院管理雜志,1992;7(8):433.
20. ［12］Ma J. Study on the new mode of DRGs system[J]. Chinese Hospital management, 1994; 14(9) :10.
21. 馬俊.DRGs系統(tǒng)新模式的研究[J].中國醫(yī)院管理,1994;14(9):10.
22. ［13］Dong J ,Zhu SJ, Cao XT. Study and application of the realtime control mode of expenses for disease entities quality [ J ].Chinese Health Quality Management, 2001; ( 1 ) :53 - 54.
23. 董軍,朱士俊,曹秀堂.病種質(zhì)量費用實時控制模式研究與應(yīng)用[J].中國衛(wèi)生質(zhì)量管理,2001;(1):53～54.
24. ［14］Dong J, Hu DK, Chen JW. Experimental study on the criteria for the control of expenses for different disease entities[J].Chinese Jourual of Hospital Administration, 2001; 17 ( 9 ): 529-531.
25. 董軍,胡德奎,陳劍偉.病種費用控制標(biāo)準(zhǔn)實驗研究[J].中華醫(yī)院管理雜志,2001;17(9):529～531.
26. ［15］Shi BH, Hu DG, Dong J. Analysis and study on the control table of expenses for different disease entities [J ]. Chinese Journal of Hospital Administration, 2001; 17 ( 9 ): 532 - 533.
27. 石冰河,胡德奎,董軍.病種費用控制圖的分析與研究[J].中華醫(yī)院管理雜志,2001;17(9):532～533.
  1. 1. ［1］Zhu SJ, Dong J. Chief-editor. Hospital administration and information utilizing[ M ]. Beijing: People’ s Military Publisher,2000: 57 - 59.
  2. 2. 朱士俊,董軍主編.醫(yī)院管理與信息利用[M].北京:人民軍醫(yī)出版社,2000:57～59.
  3. 3. ［2］Fu Z, Ren LZ. Hospital information system construction and application. Beijing: People’ s Military Publisher, 2002.
  4. 4. 傅征,任連仲.醫(yī)院信息系統(tǒng)建設(shè)與應(yīng)用[M].北京:人民軍醫(yī)出版社,2002.
  5. 5. ［3］Dong J, Liu ZM, Cao XT, Li YP, Sun Xin, Zhou YC, Zhang YL,Xie LX, Xu WY, Wang HT, Xu HM. Construction of SARS Information System in Xiao Tang Shan Hospital [ J ].Chinese Journal of Evidence-Based Medicine. 2004; 4 ( 3 ): 181- 186.
  6. 6. 董軍,劉志敏,曹秀堂,李幼平,孫鑫,周亞春,張雁靈,解立新,徐武夷,王海濤,許紅民.小湯山醫(yī)院SARS診療信息數(shù)據(jù)庫建設(shè)[J].中國循證醫(yī)學(xué)雜志,2004;4(3):181～186.
  7. 7. ［4］Dong J, Cao XT, Sun X, Zhou YC, Chen HW,Yuan ZJ,Liu ZM,Wang HT,Xu HM. Medical expenditure and influential factor analysis of 680 SARS cases[J]. Chinese Journal of Evidence-Based Medicine, 2003; 3(3):222-230.
  8. 8. 董軍,曹秀堂,孫鑫,周亞春,陳杭薇,袁志軍,劉志敏,王海濤,許紅民.680例SAKS臨床確診患者醫(yī)療費用和影響因素分析[J].中國循證醫(yī)學(xué)雜志,2003,3(3):222～230.
  9. 9. ［5］Zhang L, Dong J. The principle and methodology of case by classification [ J ]. Hospital Administration Journal of Chinese People’ s Liberation Army, 2000 ;7 (2): 101 - 103張力,董軍.病例分型的原則與方法[J].解放軍醫(yī)院管理雜志,2000;7(2):101～103.
  10. 10. ［6］Zhang L, Wang WZ. Characteristics and technical points of case by classification[J]. Chinese Journal of Hospital Administration, 2000; 16 (7) :392 - 393.
  11. 11. 張力,王文中.病例分型的特點和技術(shù)要點[J].中華醫(yī)院管理雜志,2000;16(7):392～393.
  12. 12. ［7］Zhang L, Dong J. Application of case by classification in the evaluation of case quality [J ]. Chinese Journal of Hospital Administration,2000; 16 (7): 394 - 398.
  13. 13. 張力,董軍.病例分型在病例質(zhì)量評價中的應(yīng)用[J].中華醫(yī)院管理雜志,2000;16(7):394～398.
  14. 14. ［8］Zhang L, Dong J. Difficulty and countermeasure of case by classificafion[J ]. Chinese Journal of Hospital Administration,2000; 16(7) :408.
  15. 15. 張力,董軍.病例分型的難點和對策[J].中華醫(yī)院管理雜志,2000;16(7):408.
  16. 16. ［9］Hugh SA, Leonie M. Casemix for all[ M ]. Redcliffe Medical Press, 1999. 5 - 16.
  17. 17. ［10］Forgione DA, D’ Annunzio CM. The use of DRGs in health care payment systems around the world[J ], J health Care Finance ,1999; 26:66 -78.
  18. 18. ［11］Huang HY. Development of DRGs in U. S. A[J]. Chinese Journal of Hospital Administration, 1992 ;7(8): 433.
  19. 19. 黃慧英.診斷相關(guān)分類法DRGs在美國的發(fā)展[J].中華醫(yī)院管理雜志,1992;7(8):433.
  20. 20. ［12］Ma J. Study on the new mode of DRGs system[J]. Chinese Hospital management, 1994; 14(9) :10.
  21. 21. 馬俊.DRGs系統(tǒng)新模式的研究[J].中國醫(yī)院管理,1994;14(9):10.
  22. 22. ［13］Dong J ,Zhu SJ, Cao XT. Study and application of the realtime control mode of expenses for disease entities quality [ J ].Chinese Health Quality Management, 2001; ( 1 ) :53 - 54.
  23. 23. 董軍,朱士俊,曹秀堂.病種質(zhì)量費用實時控制模式研究與應(yīng)用[J].中國衛(wèi)生質(zhì)量管理,2001;(1):53～54.
  24. 24. ［14］Dong J, Hu DK, Chen JW. Experimental study on the criteria for the control of expenses for different disease entities[J].Chinese Jourual of Hospital Administration, 2001; 17 ( 9 ): 529-531.
  25. 25. 董軍,胡德奎,陳劍偉.病種費用控制標(biāo)準(zhǔn)實驗研究[J].中華醫(yī)院管理雜志,2001;17(9):529～531.
  26. 26. ［15］Shi BH, Hu DG, Dong J. Analysis and study on the control table of expenses for different disease entities [J ]. Chinese Journal of Hospital Administration, 2001; 17 ( 9 ): 532 - 533.
  27. 27. 石冰河,胡德奎,董軍.病種費用控制圖的分析與研究[J].中華醫(yī)院管理雜志,2001;17(9):532～533.