Analysis of Non-Grouped Cases and Improvement Measures Under the DRGs Settlement Model in a Specialized Hospital
Objective To analyze the issues of non-grouped cases in a specialized hospital under the DRGs settlement model and propose corresponding improvement measures.Methods Through retrospective analysis and expert discussions,a total of 300 non-grouped cases were collected and analyzed from 33 935 cases uploaded to the municipal medical insurance platform case information management system from January 2021 to June 2022 in a specialized hospital.Results The main reasons for non-grouped cases included gray codes for the primary diagnosis or procedure codes,changed in medical insurance versions resulting in the transformation of valid primary diagnoses into invalid ones,lack of proper comparison between the national clinical version and the medical insurance version for primary diagnosis codes,and errors in the selection of the main diagnosis by clinical physicians.Conclusion Through a comprehensive analysis of non-grouped cases under the hospital's DRGs settlement model,improvement measures can be identified,such as strengthening training for clinical physicians and coders,enhancing quality control of medical records,and improving information system construction,in order to improve the DRGs inclusion rate.
DRGs settlement modelnon-enrolled casesmedical record homepageprimary diagnosiscodingcoder
万方数据
维普
