Data analysis of QY Group in urology department of a three A and tertiary hospital
Objective In order to reasonably reduce QY group and improve the accuracy of DRG,we analyzed the data of QY(ambiguity)group in the Diagnosis Related Groups in urology department of a three A and tertiary hospital.Methods Medical insurance settlement statements of urology department of a hospital in the DRG sub-platform of a municipal medical insur-ance bureau were collected from April 1,2022 to November 30,2022,extracting QY cases.The medical records of QY cases were extracted from the digital medical record browser of a hospital.Senior quality control physicians were organized to check medical records,disease classification and medical insurance settlement statements of QY group cases,analyzing the cases.Excel 2010 was used for statistical analysis of the data.Results ① 2 810 copies of medical insurance settlement statements were obtained,of which 43 cases were in the QY groups,accounting for 1.53％.②The cases mainly distributed in urinary system tumors(27.91％),neurogenic bladder(18.60％),prostatic hyperplasia(16.28％),ureteral diseases(11.62％),and ure-thral diseases(11.62％).(3)The total hospitalization cost of patients in QY groups was 731 684.1 yuan,and the average hospi-talization cost was 17 015.91 yuan.The total payment amount of DRG was 419 807.24 yuan,and the average payment amount was 9 762.96 yuan.④The causes of QY groups were as follows:There were 14 cases of DRG grouping rule defect,accounting for 32.56％;There were 29 cases of hospital management defects,accounting for 67.44％.Among the hospital management de-fects,13 cases(30.23％)of the medical insurance settlement statements were defective;There were 8 cases(18.60％)of er-rors in doctors'major diagnoses and major surgical operations.There were 8 cases(18.60％)of coding errors in major diagno-ses and major surgical operations.Conclusion To reasonable reduction QY group,it is necessary to optimize DRG grouping rules and strengthen hospital internal management.Only by paying attention to improve the connotation quality of medical re-cords,accurately classify disease and surgical name,strengthen the management and review of medical insurance settlement state-ments,and establish a long-term mechanism for DRG data quality control,we can further improve the accuracy of DRG and ac-tively promote the reform of medical insurance payment.
QY casesDRGThe front page of medical recordsMedical insurance settlement statement
万方数据
维普
