Preface The traditional way of medical quality management has been emphasizing other indicators except for clinical criteria in macao, this imbalance should be addressed. It should be applied to explore new clinical standard for quality management of disease and combined it with comprehensive clinical protocol. It should integrate the target-oriented quality control over common diseases with that of difficulty and complicated diseases, as well as integrate case quality control with casemix quality control. We should learning from the experience of Chinese in a more creative way. Argumentation Keeping up with international standard is the new tendency of this century. In order to pursue high quality, hospitals must adopt high standard. In the future, going with the current of the times, the hospital quality management would regards the rigorous quality as the goal, and it will based on the digital computer and net. By means of the continuous quality improvement, innovation, and integrating the scientific and cultural management, the hospital quality management will facilitate achieving the destination. In 1980's, the casemix classification management was introduced by professor MaJin. Medical institutions (which have the same meaning with hospitals in this paper) apply casemix classification management in order to raise the service quality and satisfy patient's clear and implied demands. It is possible to decrease the cost, make the best use of health resources, enhance profit of medical institutions and provide basis for the formulation and perfection of medical security policies by carrying out casemix classification management. Consequently, the integration with casemix classification management and standard-cost management of medical institutions in worth studying. Subjects 1. The present situation of medical system of macao. 2. The initial review and estimation of medical system of macao. 3. Compare with the hot points and prospect in the research of Chinese hospital quality management (hospital quality real-time control, clinical pathway, ISO9000 quality system verification, continuous quality improvement, evidence-based medicine, casemix classification management and physician-in-charge responsibility system.). 4. The study and development of casemix classification management. 5. The basic contents and methods of casemix classification management. 6. The application of information of casemix classification management. 7. The establishment of casemix classification management in private hospital of macao. Objectives 1. To analyze the medical system of macao. 2. In order to acquire and strengthen the advantages considered important of casemix classification management through introducing and analyzing the standard of casemix classification management. Methods 1. Data collection 2. Summary of literature 3. To conduct preliminary study in application of CD rate and quality evaluation of casemix classification management Results In doing so it highlighted respectively the following aspects: Preparations for the implementation, intensified training, compilation of software on the casemix classification management system, operation of the casemix classification management system, examination and verification of the internal quality system, examination and verification of quality system, and application of information of casemix classification management. When using this system, hospitals must considerate their own situation, advocate their staff, and make good choices of computer consulting company. The most important thing is its actual effect. Conclusions The experience is that implementation of casemix classification management is a new means of constructing a mode of modem medical quality management; it is a prerequisite for the sustained development of a hospital; and it guarantees organizationally the effective operation of medical quality management. Key words Casemix classification; Management; System; CD rate; quality evaluation

前言 在澳門醫療系統管理中,傳統的質量管理方法著重指標而輕視臨床,是需要解決的問題。應該尋求新的臨床標准,運用臨床綜合流程提供新的工作方式。要把常見病種指標質控與疑難重病臨床質控結合起來,把病種質控與病例質控組合起來。學習國內經驗要深入理解,走創新之路。 立論依據 與國際標准接軌,是新世紀醫院質量管理新動向。醫院追求高質量,必須採用高標准。醫院質量管理發展趨勢是以超嚴質量要求為目標,數字化管理為基礎,持續質量改進和質量管理創新為手段,科學管理和“文化管理”的有機結合為根本。 病例分型於20世紀80年代初由我國著名醫院管理專家馬駿教授提出。醫療機構實施病例分型管理,其目的是為了提高醫療服務質量,滿足病人一切明確和隱含的需 求。可籍它來降低醫療質量成本、充分利用衛生資源來促進經濟效益的提高,為制定、 完善醫保政策提供依據。故此,病例分型管理與標准費用管理的整合,是一個值得研究的課題。 研究內容 1. 澳門醫療衛生系統的現況。 2. 澳門現行醫療衛生系統的初步檢討及評估(澳門醫療系統有哪些有利因素和不利因素)。 3. 比較當前中國醫院質量管理的研究熱點(醫療質量實時控制、持續質量改進、 ISO9000 質量體系認証、循証醫學、臨床途徑、病例分型管理、主診醫師負責制)。 4. 病例分型管理的研究與發展。 5. 病例分型管理的基本內容和方法。 6. 病例分型管理資訊的應用(對危重病例率、質量評價的指標作分析)。 7. 澳門私立醫院病例分型管理實施方案 研究目的 1. 分析澳門醫療衛生系統的模式; 2. 通過對病例分型管理概況的介紹,以及各質量指標與醫院質量管理的關系的分 析,意在進一步瞭解病例分型管理標准的內涵,提高對病例分型管理在澳門私立 醫院質量管理標准化建設方面重要意義的認識。 研究方法 1. 資料收集(來源於解放軍醫院管理雜志、中國衛生質量管理雜志、中華醫院管理 雜志等的文獻,參考廣州南方醫院推行病例分型管理的措施)； 2. 文獻綜述； 3. 應用危重病例率、質量評價的指標作病例分型分析。 結果 在病例分型管理體系的實施中首先抓貫標准備,其次抓強化培訓,第三抓質量體 系軟件編寫,第四抓質量管理體系運行,第五抓內部質量體系審核,第六應用病例分 型資訊。醫院採用病例分型管理體系,應考慮自己的總體條件,做好思想發動,選好電腦咨詢公司,講究實際效果。 結論 病例分型管理體系的應用中主要體會是實標;是構築現代醫療質量管理的一種新 方式:是醫院可持續發展的前提;是醫療質量管理有效運行的組織保障。 關鍵詞:病例分型 管理 體系 危重病例率質量評價