Multi-dimensional performance point number measuring and calculating method

Abstract

The invention discloses a multi-dimensional performance point number measuring and calculating method, which belongs to the technical field of medical quality management, and comprises the following steps: 1) constructing a medical four-dimensional index system: presetting four dimensions of clinical quality, patient safety, operation efficiency and scientific research and innovation, integrating DRG grouping and JCI standard related indexes, and when a new diagnosis and treatment project is added, establishing a medical four-dimensional index system; automatically associating exclusive indexes through clinical path mapping; 2) three-drive weight dynamic adjustment: strategic drive: adjusting strategic key dimension weight through a management end interface; according to the method, medical special indexes such as a DRG-CM I value and D-to-B time are brought into performance, 12 JCI core standard indexes are covered, a weight fusing mechanism realizes medical insurance compliance one-ticket override, compared with a traditional method, the response speed is increased by 70%, the problem that workloads of different departments are incomparable is solved through a case difficulty coefficient, hyper-branched cases are automatically traced through medical insurance-performance linkage, and the efficiency of medical insurance-performance linkage is improved. After implementation in a certain hospital, the medical insurance refusing rate is reduced by 32%, and a doctor can master personal / department / whole hospital three-level performance ranking in real time through early warning of the mobile terminal.

Description

Technical Field

[0001] The present invention belongs to the technical field of medical quality management, and in particular relates to a multi-dimensional performance integral point calculation method. Background Art

[0002] Medical quality management is an important means to ensure the quality and safety of medical services.

[0003] At present, the following pain points exist in medical assessment: traditional performance evaluation focuses on workload (such as outpatient volume), neglects medical quality (such as misdiagnosis rate) and patient safety (such as hospital-acquired infections), is unable to dynamically respond to policy changes such as the medical insurance DRG payment reform and JCI certification standards, and the differences in case complexity between different departments (such as emergency and rehabilitation departments) are not reflected in performance evaluation. Summary of the Invention

[0004] The purpose of the present invention is to propose a multi-dimensional performance point calculation method in order to solve the above-mentioned problems.

[0005] To achieve the above objectives, the present invention adopts the following technical solution: a multi-dimensional performance point calculation method, which includes the following steps:

[0006] 1) Build a four-dimensional medical indicator system: pre-set the four dimensions of clinical quality, patient safety, operational efficiency, and scientific research innovation, integrate DRG grouping and JCI standard-related indicators, and automatically associate exclusive indicators through clinical pathway mapping when adding new diagnosis and treatment items;

[0007] 2) Dynamic adjustment of weights driven by three factors: strategy-driven, adjusting the weights of strategic key dimensions through the management interface; data-driven, with the system automatically identifying the most volatile indicators; and compliance-driven, triggering weight circuit breakers when indicators reach medical insurance / safety red lines.

[0008] 3) Case complexity correction score: The dimension score is corrected based on the DRG group difficulty coefficient, and the comprehensive score is adjusted using the medical risk coefficient;

[0009] 4) Triple early warning and feedback: Quality early warning: monitors abnormal fluctuations in medical record defect rates through Cusum control charts and recommends improvement plans; Safety early warning: automatically generates special improvement plans for fall prevention / infection prevention when the RPN risk value exceeds 200; Regulatory early warning: pushes a list of abnormal DIP payment cases and traces the responsible doctor when medical insurance overspending occurs.

[0010] As a further description of the above technical solution:

[0011] In the step 1), for clinical quality, the medical record grade A rate and surgical complication rate are collected from the EMR system; for patient safety, the nosocomial infection rate is obtained from the hospital infection control system, and the fall rate is obtained from the nursing system; for operational efficiency, the DRG group number and CMI value are extracted from the HIS system, and the drug ratio is obtained from the medical insurance system; for scientific research innovation, the number of clinical projects and the number of guideline participants are synchronized from the scientific research system; when adding day surgery, the system automatically adds the 24-hour readmission rate by matching the clinical pathway name to the historical indicator library; after the administrator confirms, the indicator data is automatically captured from the medical record system.

[0012] As a further description of the above technical solution:

[0013] In step 2), strategic adjustments and weight adjustments are synchronized to the assessment plans of all departments in real time; data-driven, the system calculates the coefficient of variation of each indicator in the past 30 days. If the coefficient of variation of the CMI value is greater than 0.2, the weight of the operational efficiency dimension is automatically increased by 5%; compliance-driven, when the intensity of antibiotic use in a department is greater than 40DDDs, the score of the indicator is directly reset to zero and marked as a red alert. After triggering the circuit breaker, the system automatically freezes the performance payment of the department until the indicator rectification meets the standards.

[0014] As a further description of the above technical solution:

[0015] In step 3), difficulty coefficient = DRG average fee / hospital average fee × complication coefficient; department average difficulty coefficient = Σ (number of cases × difficulty coefficient) / total number of cases.

[0016] In summary, due to the adoption of the above technical solution, the beneficial effects of the present invention are:

[0017] In this invention, medical-specific indicators such as DRG-CMI value and D-to-B time are incorporated into performance, covering 12 JCI core standard indicators. The weighted circuit breaker mechanism realizes a veto on medical insurance compliance, which increases the response speed by 70% compared with traditional methods. The case difficulty coefficient solves the problem of incomparable workloads in different departments. The medical insurance-performance linkage automatically traces overspending cases. After implementation in a certain hospital, the medical insurance refusal rate dropped by 32%. Mobile terminal early warning allows doctors to grasp the three-level performance rankings of individuals / departments / the whole hospital in real time. BRIEF DESCRIPTION OF THE DRAWINGS

[0018] Figure 1 The figure is a flowchart of a multi-dimensional performance point calculation method. DETAILED DESCRIPTION

[0019] The following will clearly and completely describe the technical solutions in the embodiments of the present invention in conjunction with the accompanying drawings. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without making any creative efforts shall fall within the scope of protection of the present invention.

[0020] Example:

[0021] S01: Build a four-dimensional medical indicator system: pre-set the four dimensions of clinical quality, patient safety, operational efficiency, and scientific research innovation, integrate DRG grouping and JCI standard-related indicators, and automatically associate exclusive indicators through clinical pathway mapping when adding new diagnosis and treatment items;

[0022] For clinical quality, the medical record grade A rate and surgical complication rate are collected from the EMR system. For patient safety, the hospital infection rate is obtained from the hospital infection control system, and the fall rate is obtained from the nursing system. For operational efficiency, the DRG group number and CMI value are extracted from the HIS system, and the drug ratio is obtained from the medical insurance system. For scientific research innovation, the number of clinical projects and the number of guideline participants are synchronized from the scientific research system. When adding a new day surgery, the system automatically adds the 24-hour readmission rate by matching the clinical pathway name to the historical indicator library. After the administrator confirms, the indicator data is automatically captured from the medical record system.

[0023] Specifically, clinical quality (40%): PCI procedure success rate, acute myocardial infarction D-to-B time compliance rate;

[0024] Patient safety (25%): anticoagulant error rate, catheter infection rate;

[0025] S02: Dynamic adjustment of weights driven by three factors: strategy-driven, adjusting the weights of strategic key dimensions through the management interface; data-driven, the system automatically identifies the indicators with the largest fluctuations; compliance-driven, triggering weight circuit breakers when indicators reach medical insurance / safety red lines;

[0026] Strategic adjustments and weight adjustments are synchronized to all department assessment plans in real time. Data-driven, the system calculates the coefficient of variation of each indicator over the past 30 days. If the coefficient of variation of the CMI value is greater than 0.2, the weight of the operational efficiency dimension is automatically increased by 5%. Compliance-driven, when the intensity of antibiotic use in a department is greater than 40DDDs, the indicator score is directly reset to zero and marked as a red alert. Once a circuit breaker is triggered, the system automatically freezes the department's performance payment until the indicator is corrected and meets the standard.

[0027] Specifically, the patient safety weight increased from 25% to 30% due to catheter infection events;

[0028] Data-driven adjustments: Due to large fluctuations in D-to-B time, the weight of this indicator increased from 12% to 18%;

[0029] S03: Case complexity correction score: The dimension score is corrected based on the DRG group difficulty coefficient, and the comprehensive score is adjusted using the medical risk coefficient;

[0030] Difficulty coefficient = DRG average fee / hospital average fee × complication coefficient; department average difficulty coefficient = Σ (number of cases × difficulty coefficient) / total number of cases;

[0031] Specifically, a doctor's PCI success rate is 98% (S grade 120 points), and his D-to-B compliance rate is 85% (A grade 100 points). The corrected score = (120 × 18% + 100 × 12%) × 40% × 1.0 (risk factor) = 14.4 points.

[0032] S04: Triple early warning and feedback: Quality early warning, using Cusum control charts to monitor abnormal fluctuations in medical record defect rates and push improvement plans; Safety early warning, automatically generating special improvement plans for fall prevention / infection prevention when the RPN risk value is greater than 200; Regulation early warning, pushing a list of abnormal DIP payment cases and responsible doctor tracing when medical insurance overspending occurs;

[0033] Specifically, the system prompts that the doctor's anticoagulant error rate is higher than the department average and pushes a medication verification form template.

[0034] The above description is only a preferred specific embodiment of the present invention, but the scope of protection of the present invention is not limited thereto. Any technician familiar with the technical field, within the technical scope disclosed by the present invention, who makes equivalent replacements or changes based on the technical solution and inventive concept of the present invention, should be covered by the scope of protection of the present invention.

Claims

1. A multi-dimensional performance point calculation method, characterized by: The steps include: 1) Build a four-dimensional medical indicator system: pre-set the four dimensions of clinical quality, patient safety, operational efficiency, and scientific research innovation, integrate DRG grouping and JCI standard-related indicators, and automatically associate exclusive indicators through clinical pathway mapping when adding new diagnosis and treatment items; 2) Dynamic adjustment of weights driven by three factors: strategy-driven, adjusting the weights of strategic key dimensions through the management interface; data-driven, with the system automatically identifying the most volatile indicators; and compliance-driven, triggering weight circuit breakers when indicators reach medical insurance / safety red lines. 3) Case complexity correction score: The dimension score is corrected based on the DRG group difficulty coefficient, and the comprehensive score is adjusted using the medical risk coefficient; 4) Triple early warning and feedback: Quality early warning: monitor abnormal fluctuations in medical record defect rates through Cusum control charts and recommend improvement plans; Safety early warning: automatically generate special improvement plans for fall prevention / infection prevention when the RPN risk value is greater than 200; Regulations warning, push DIP payment abnormal case list and responsible doctor tracing when medical insurance overspending.

2. A multi-dimensional performance points calculation method according to claim 1, characterized in that: In step 1), for clinical quality, the medical record grade A rate and surgical complication rate are collected from the EMR system; for patient safety, the nosocomial infection rate is obtained from the hospital infection system, and the fall rate is obtained from the nursing system; For operational efficiency, the number of DRG groups and CMI values are extracted from the HIS system, and the drug share ratio is obtained from the medical insurance system; for scientific research innovation, the number of clinical projects and the number of guideline participants are synchronized from the scientific research system; when adding day surgeries, the system automatically adds the 24-hour readmission rate by matching the clinical pathway name to the historical indicator library; after the administrator confirms, the indicator data is automatically captured from the medical record system.

3. A multi-dimensional performance points calculation method according to claim 1, characterized in that: In step 2), strategic adjustments and weight adjustments are synchronized to the assessment plans of all departments in real time; data-driven, the system calculates the coefficient of variation of each indicator in the past 30 days. If the coefficient of variation of the CMI value is greater than 0.2, the weight of the operational efficiency dimension is automatically increased by 5%; compliance-driven, when the intensity of antibiotic use in a department is greater than 40DDDs, the score of the indicator is directly reset to zero and marked as a red alert. After triggering the circuit breaker, the system automatically freezes the performance payment of the department until the indicator rectification meets the standards.

4. A multi-dimensional performance points calculation method according to claim 1, characterized in that: In step 3), difficulty coefficient = DRG average fee / hospital average fee × complication coefficient; department average difficulty coefficient = Σ (number of cases × difficulty coefficient) / total number of cases.

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