S-DRG分组器的构建与改进方法  

Establishment and Improvement of S-DRG Grouping Tool

作　　者：魏倩 陈尔真[1] 孙木[2] WEI Qian;CHEN Erzhen;SUN Mu(Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China)

机构地区：[1]上海交通大学医学院附属瑞金医院,上海200025 [2]上海交通大学医学院附属瑞金医院统计信息科,上海200025

出　　处：《中国卫生质量管理》2020年第1期61-65,共5页Chinese Health Quality Management

基　　金：上海申康医院发展中心研究课题(2013SKMR)。

摘　　要：S-DRG借鉴了澳大利亚AR-DRG的构建方法,历经了5年的本土化。根据国家临床重点专科建设项目评分标准,重新诠释ADRG。利用上海市的病案首页数据,结合我国诊断和手术编码的特点,构建主要诊断排除库和CCL,并在实践中和临床专家一起不断完善。手术组(S组)和重要的操作组(O组)采用轮询法,解决一次住院、实施多次手术或操作的病例入组叠加问题。在住院病案首页增加转归情况,杜绝未治疗的疾病被误判为有效的CC。建议国家尽快推进ICD11,淘汰ICD-9-CM-3体系,选择可结构化的手术和操作代码,并尽快统一全国的基于DRG的成本核算办法。The S-DRG referred to the construction method of Australian AR-DRG system,and has gone through five years of localization.The ADRGs were reinterpreted according to the scoring criteria of national key clinical specialty construction project.The main diagnostic exclusion library and CCL were constructed based on the data from the front page of Shanghai's medical records,combined with the characteristics of diagnosis and surgical coding in China,and continuous improvement with clinical experts in practice.The surgery group(S group)and the important operation group(O group)adopted the polling mode method to solve the problem of overlapping the cases that were hospitalized once and performed multiple surgeries or operations.In order to prevent untreated diseases from being misjudged as effective CC,the prognosis of patients'condition was added to the front page of inpatient medical records.It is suggested that the National Health Commission promote the ICD-11 system,and eliminate the ICD-9-CM-3 system,select the structured surgery and operation codes,and unifie the DRG-based cost accounting method as soon as possible.

关 键 词：诊断相关分组 本土化 相对权重 

分 类 号：R197.322[医药卫生—卫生事业管理]