DRG付费下某院误入高倍率病案的住院病案首页缺陷分析
Defect Analysis on the First Page of Mistakenly in High-rate Cases under DRG Payment
降凌燕 1王亚慧 1王宇江 1路殿英 1李韶霞1
作者信息
- 1. 长治医学院附属和平医院病案管理科,山西省,长治市,046000
- 折叠
摘要
目的 通过分析某三甲医院基于DRG付费下的高倍率病案,探究高倍率病案的误入原因,提出优化措施.方法 回顾研究医保局反馈的 2021年 1月 1 日-2021年 6 月 30 日出院的 411份高倍率病案,由主治医师以上和通过中国医院协会病案管理专业委员会颁发的"国际疾病分类与手术操作分类编码技能水平考试合格证"的 3 名编码员,依据规则逐份汇总核查,重点质控出院诊断及手术操作,并核查与入院记录/病程记录及手术记录等的一致性,并对其缺陷异常进行问题分类和分析.结果 411 份高倍率病案中有30 份病历误入高倍率;原因主要为分组方案争议病案 13 份(43.33%);医师主要诊断以及主要手术选择错误、漏写手术操作、漏写其他诊断错误共有 11 份(36.67%);编码员漏录手术操作、主要诊断以及主要手术编码错误共 6 份(20.00%).结论 住院病案首页缺陷导致误入高倍率病例组的主要原因是主要诊断和主要手术选择错误,通过加强培训和住院病案首页全流程质控,持续改进住院病案首页数据质量,从而提高DRG入组准确率.
Abstract
Objectives By analyzing the high-rate cases in a hospital based on DRG payment,explore the reasons and propose measures to reduce the rate of high-rate cases.Methods Review and study 411 high-rate medical records received from the Medical Insurance Bureau from January 1st,2021 to June 30th,2021,by attending physicians and three coders who passed the Certificate of"International Classification of Diseases and Surgical Operation Classification Coding Skill Level Examination"issued by the Medical Records Management Committee of the Chinese Hospital Association,and collect and check them one by one according to the rules.Focus on quality control discharge diagnosis and surgical operation,and check the consistency with admission records/course records and surgical records,and classify and analyze the defects and abnormalities.Results 30 of the 411 cases mistakenly in high-rate cases.13 were disputed due to DRG grouping scheme,accounting for 43.33%.There were 11 doctors'mistakes in main diagnosis,main operation selection,omission of operation,and wrong filling of admission condition,accounting for 36.67%;The coder omitted surgical procedures,main diagnoses and main surgical coding errors,accounting for 20.00%.Conclusions The main reason that the inpatient medical record front page defects led to the high rate of cases group was the main diagnosis and main surgical selection errors.Through strengthening training and quality control of the whole process of the inpatient medical record front page,the data quality of the inpatient medical record front page was continuously improved,so as to improve the accuracy of DRG inclusion.
关键词
诊断相关分组(DRG)/高倍率病案/住院病案首页Key words
Diagnostic correlation grouping(DRG)/High-rate case/Front page of medical records引用本文复制引用
出版年
2024
NETL
NSTL
万方数据