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目的探讨病例死亡风险分级方法,为提高医院综合诊治和管理水平提供方向,为医疗质量评价提供参考。方法以9008例循环系统住院病例为例,以主诊断转归为目标变量,应用卡方自动交互作用检测法CHAID进行分组,并对急性心肌梗死组分年度进行初步评价。结果样本共计分为35个不同死亡风险的组,归入零风险组、超低风险组、低风险组、高风险组和超高风险组五级。其中急性心肌梗死组,低风险组和超高风险组各年度死亡率不同,说明利用零风险组、超低风险组和低风险组患者群死亡率进行基础医疗质量评价更为合理和敏感,而利用高风险组和超高风险组患者群死亡率可进行医院危重救治能力和综合管理水平方面的评价。结论可将病例进行死亡风险分级,并用于科间、院间或不同时段医疗质量评价。
Objective To explore the risk stratification method of case death, to provide direction for improving the comprehensive diagnosis, treatment and management of hospitals and to provide reference for the evaluation of medical quality. Methods 9008 cases of circulatory system inpatients as an example, the main diagnosis and outcome as the target variable, using chi square automatic interaction detection method CHAID grouping, and the annual assessment of the components of acute myocardial infarction. Results The samples were divided into 35 groups with different risk of death and classified into five groups: zero risk group, ultra low risk group, low risk group, high risk group and ultra high risk group. Among them, the annual mortality rates in acute myocardial infarction group, low risk group and ultra-high risk group were different, which indicated that it is more reasonable and sensitive to evaluate the basic medical quality by using the group mortality of patients in the low risk group, the ultra low risk group and the low risk group, The use of high-risk group and ultra-high risk group of patients mortality rate can be critically ill hospital emergency treatment and comprehensive management evaluation. Conclusion The risk of death can be graded and used to evaluate the quality of medical care among departments, hospitals or different periods.