本研究基于病例报告评价只有“评语没有评分”的现状，重点讨论如何在现行病例报告质量评价工具的基础上构建适用于全学科的病例报告质量评价指标体系，并进一步用于实际分层分级量化评价病例报告，评定优秀病例报告。通过文献回顾确定评价因素，结合专家咨询方法，确定病例报告质量评价指标，应用层次分析方法和模糊理论思想为评价指标确定权重，在通过一致性评价的前提下，构建指标科学且权重合理的病例报告质量评价指标体系。基于中国临床案例成果数据库（CMCR）收集来自全国的663份不同学科病例报告，由各学科专家按照指标测度分别评定每例病例报告的评语等级，并运用分层模糊评价模型在计算机中实现病例报告质量评价分数，最终进行排序明确病例报告的质量等级。研究结果：研究构建了由3个维度，11个指标组成的权重清晰的病例报告质量评价指标体系。并通过分层模糊评价实证评定了663份病例报告分数，共得到105份优秀病例报告和446份中等等级病例报告，112份较差水平病例报告。由卡方检验确定了优秀病例报告的评定不受医院等级来源的影响，可以明确用于各级别医疗单位的病例报告质量评价，并由有序逻辑回归分析证明了分层分级评价分数与专家主观态度相对一致。

Background: Based on the policy background of promoting the reform of the " clinical representative outcome evaluation" in the medical and health field, and the reality that there is only "no scoring in comments" in case report evaluation, this study focuses on how to build a case report quality evaluation index system applicable to all disciplines on the basis of the current case report quality evaluation tool, and further use it for the actual hierarchical and quantitative evaluation of case reports to achieve evidence grading of clinical representative outcomes. Objectives: (1) To construct a hierarchical and hierarchical quality evaluation index system for case reports with clear weight. (2) A hierarchical fuzzy evaluation model was constructed for the actual quantitative evaluation of case report quality comments. (3) Formulate the measurement focus of relevant evaluation indicators based on the actual evaluation results, and standardize the quality writing standards for case reports. Methods: The evaluation factors were determined through literature review, combined with expert consultation methods, the case report quality evaluation index system was determined, the analytic hierarchy method and fuzzy theory were applied to determine the weight of the evaluation index, and a hierarchical fuzzy evaluation model was constructed. Based on the Chinese Medical Case Repository（CMCR）, 663 case reports from different disciplines were collected from all over the country, and experts in various disciplines rated the evaluation level of each case report according to the index measurement, and the hierarchical fuzzy evaluation model was used to achieve the case report quality evaluation score in the computer, and finally the quality level of the case report was sorted to clarify, and the scientific and usability of the index system and the hierarchical fuzzy evaluation model were analyzed by statistical methods. Results: A well-weighted case report quality evaluation index system consisting of 3 dimensions and 11 indicators was constructed. A score of 663 case reports was achieved, in order of score, resulting in a total of 105 excellent case reports and 446 intermediate case reports and 112 poor level case reports. The case reports of each score group showed significant differences from their disciplinary sources, with significance at the α=0.01 level (χ2=165.348, p=0.000), the correlation coefficient value between the score and the number of assessment experts -0.083, and the significance of (P=0.033) at the α=0.05 level. The ordered regression model verifies that the hierarchical quality evaluation score is relatively consistent with the subjective attitude of experts, and the evaluation score can basically explain the attitude of experts. Conclusion: The evaluation of excellent case reports is not affected by the source of hospital grade, and can be clearly used for the quality evaluation of case reports of different levels of medical units. The hierarchical grading quality evaluation score of case reports is not affected by hospital grade and expert attitude, and the differences in each discipline can be explained by the quality difference between case reports in different disciplines.