目的：慢性肾脏病矿物质及骨异常（Chronic Kidney Disease-Mineral and Bone Disorder，CKD-MBD）是慢性肾脏病的重要并发症，会显著提升患者死亡率。目前，我国血液透析患者中CKD-MBD患病率超过85%，极大地威胁人民群众生命健康，亟需对其医疗质量进行监测和评价，进一步分析差异，加强管理。本研究旨在探索适用于我国的CKD-MBD医疗质量评价指标体系，为医疗机构质量改进和卫生健康行政部门决策制定提供参考。方法：指标体系构建过程中，系统汇总梳理现有文献，发展原始指标池。通过三轮专家函询筛选关键指标，并应用层次分析法，确定不同指标的组合权重。进而在X医院开展指标体系的应用，综合直接权重相乘法和优劣解距离法，对X医院2018-2022年度CKD-MBD医疗质量进行纵向评价，对不同透析模式差异进行横向对比，对X医院和其他中心差异进行外部对比。结果：指标体系共包括一级指标3个，二级指标9个，三级指标29个。一级指标中结果类指标权重最高，组合权重为0.660。二级指标中，“治疗效果”、“并发症控制”和“药物治疗”权重排序前三。纵向评价结果发现，2018-2022年X医院CKD-MBD医疗质量持续提升，但血管钙化评估完成率、甲状旁腺手术开展率等过程指标和血磷达标率等结果指标评分较低。横向对比发现，结果指标中，X医院腹膜透析和血液透析患者的血钙达标率、甲状旁腺素达标率存在显著差异（P<0.01），血磷达标率差异无统计学差异（P>0.05）。过程指标中，血管钙化评估完成率存在显著差异（P<0.01）。外部对比发现，2022年X医院血液透析患者血钙达标率、甲状旁腺素达标率和高血磷控制率显著优于既往研究中四川省和中国平均水平（P<0.001），与北美地区结果无统计学差异（P>0.05）。结论：基于结构-过程-结果三维评价框架构建的指标体系在CKD-MBD医疗质量评价中具有适用性，其中，核心指标包括患者死亡率、血钙、血磷和甲状旁腺素综合达标率、血磷达标率。2018-2022年X医院CKD-MBD医疗质量持续提升，但血磷和甲状旁腺素总体控制水平、甲状旁腺切除术开展情况有待提高，不同透析模式患者诊疗过程同质化水平有待提升。我国不同医疗机构的CKD-MBD医疗质量存在较大差异，血磷等关键指标的整体控制水平有待进一步提高。

Objective: Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is an important complication of chronic kidney disease, which can significantly increase the mortality of patients. Currently, the prevalence of CKD-MBD in hemodialysis patients in our country is more than 85%, which is a great threat to people‘s life and health. It is urgent to monitor and evaluate the medical quality, further analyze the difference and strengthen management. The aim of this study was to explore the suitable CKD-MBD medical quality evaluation index system, which could provide reference for medical institution quality improvement and health administration decision-making.Methods: In the process of index system construction, the existing literature was systematically summarized and the original index pool was developed. The key indicators were selected through three rounds of expert correspondence consultation, and the combined weights of different indicators were determined by AHP. Furthermore, the empirical application of the index system was carried out in X Hospital, and the longitudinal evaluation of the medical quality of 2018-2022 CKD-MBD in X Hospital was conducted by combining direct weight multiply and the method of good and bad solution distance, horizontal comparison of the differences of different dialysis modes and external comparison of the differences between X Hospital and other centers.Results: The index system consisted of 3 first-level indexes, 9 second-level indexes and 29 third-level indexes. Among the first-level indicators, the weight of result index is the highest, and the weight of combination is 0.660. Among the secondary indexes, the weight of "therapeutic effect", "complication control" and "drug therapy" ranked the top three. The longitudinal evaluation results showed that the medical quality of CKD-MBD in X Hospital continued to improve from 2018 to 2022, but the process indicators such as the completion rate of vascular calcification evaluation, the rate of parathyroid operation and the outcome indicators such as the standard rate of blood phosphorus were low. Horizontal comparison showed that among the result indicators, there were significant differences in the conforming rate of blood calcium and parathyroid hormone between peritoneal dialysis and hemodialysis patients in X Hospital (P<0.01), while there was no statistical difference in the conforming rate of blood phosphorus (P>0.05). Among the process indicators, the completion rate of vascular calcification assessment was significantly different (P<0.01). External comparison showed that the conforming rate of blood calcium, conforming rate of parathyroid hormone and control rate of high blood phosphorus of hemodialysis patients in X Hospital in 2022 were significantly better than the average level of Sichuan Province and China in previous studies (P<0.001), and there was no statistical difference with the results in North America (P>0.05).Conclusion: The index system constructed based on the structure-process-result three-dimensional evaluation framework is suitable for the evaluation of medical quality of CKD-MBD, in which the core indicators include patient mortality, comprehensive standard rate of blood calcium, blood phosphorus and parathyroid hormone, and standard rate of blood phosphorus. From 2018 to 2022, the medical quality of CKD-MBD in X Hospital continued to improve, but the overall control level of blood phosphorus and parathyroid hormone, the implementation of parathyroidectomy need to be improved, and the homogenization level of diagnosis and treatment process of patients with different dialysis modes needs to be improved. There are great differences in the medical quality of CKD-MBD in different medical institutions in our country. The overall control level of key indicators such as blood phosphorus should be further improved.