实用老年医学

实用老年医学 ›› 2021, Vol. 35 ›› Issue (5): 537-540.doi: 10.3969/j.issn.1003-9198.2021.05.029

• 病案管理 • 上一篇    

利用DRGs原理提升老年医学科疾病管理水平

徐岚, 张殿福, 朱峰   

  1. 211200 江苏省南京市,南京溧水区人民医院(东南大学附属中大医院溧水分院)病案管理科(徐岚,朱峰);老年医学科(张殿福)
  • 收稿日期:2020-10-30 出版日期:2021-05-20 发布日期:2021-05-25

Application of diagnosis-related groups in improving disease management in department of geriatrics

XU Lan, ZHU Feng, ZHANG Dian-fu   

  1. XU Lan, ZHU Feng. Medical Record Room; ZHANG Dian-fu. Department of Geriatrics, Lishui Branch of Zhongda Hospital, Southeast University, Nanjing 211200, China
  • Received:2020-10-30 Online:2021-05-20 Published:2021-05-25

PDF (PC)

1289

摘要： 目的 通过分析老年医学科诊断相关组(DRGs)分组费用异常数据,发现病案首页填写问题,并针对问题进行培训,以提升老年医学科疾病管理的水平。方法 提取东南大学附属中大医院溧水分院老年医学科2019年1~6月出院病历中基于DRGs分组为异常的病案,将其分为极高费用病案、极低费用病案以及未入组病案,分析病案发生异常的原因,并结合DRGs分组原理对医生进行针对性培训。收集培训后2020年1~6月出院病案,分析病案首页填写水平的变化,并以此反映其疾病管理水平的提升情况。结果 共获取2019年1~6月890份出院病案,其中极高费用病案50份(占5.62%)、极低费用病案21份(占2.36%)、未入组病案33份(占3.71%),病案首页诊断与手术操作填写合格率为83.22%。异常病案的主要原因为诊断选择错误、诊断遗漏、诊治名称不规范、治疗选择错误等。经过培训后,分析2020年1～6月老年医学科685份出院病案,其中极高费用病案7份(占1.02%)、极低费用病案9份(占1.31%)、未入组病案4份(占0.58%),病案首页诊断与手术操作填写合格率为96.35%。与2019年同期相比,2020年老年医学科出院极高费用病案、极低费用病案及未入组病案发生率明显下降(P均<0.05);首页填写合格率明显提升(P<0.05)。结论 通过基于DRGs分组费用异常病案的分析,有针对性地对老年医学科医生进行培训,可显著提升老年医学科医生病案首页填写水平,同时提升了疾病管理水平。

关键词: 疾病诊断相关组, 老年医学科, 病案首页, 疾病管理

Abstract: Objective To explore the feasibility of using diagnosis-related groups(DRGs) to improve the level of disease management in Department of Geriatrics based on analysis of the abnormal cost of DRGs and training. Methods A total of 890 geriatric medical records of the discharged patients from January to June 2019 were collected,and all the abnormal cost records including extremely high cost records, very low cost records and ambiguous medical records were extracted. The geriatricians were trained based on the questions that acquired by the encoders and quality control doctors based on the DRGs principle. After training, a total of 685 medical records of the discharged patients from January to June 2020 were collected. The filling level in the medical record home page was evaluated. Results In the first half of 2019, the prevalence of the abnormal cases was 11.69% (104 cases), including 50 extremely high cost records (5.62%), 21 very low cost records (2.36%) and 33 ambiguous medical records (3.71%). The qualified rate of filling diagnosis and treatment in the medical record home page was 83.22%. The main reasons of abnormal medical records were choosing errors of diagnosis, omission of diagnosis, diagnosis or treatment name be not standardized and choosing errors of treatment. Compared with the first half of 2019, there were only 7 extremely high cost records (1.02%), 9 very low cost records (1.31%) and 4 ambiguous medical records (0.58%) in the first half of 2020 (all P＜0.05), and the qualified rate of filling in the home page was significantly enhaced (96.35 vs 83.22%, P＜0.05). Conclusions By the analysis of the abnormal typical cases and training based on the DRGs principle, the filling level in the medical record home page can be improved significantly, which reflects the improvement of diseases management level of Department of Geriatrics.

Key words: diagnosis-related groups, department of geriatrics, medical record home page, disease management

中图分类号: