主要诊断选择对DRG入组和权重变化的影响  

Effects of major diagnostic choices on DRG grouping and weight changes

作　　者：黄昊[1] 张丽[1] 王颖[1] 邓应梅[1] 刘春玲[1] 焦卫平[1] 吴英锋[1] 张晨[1] 仇叶龙[1] 韩优莉[2] Huang Hao;Zhang Li;Wang Ying;Deng Yingmei;Liu Chunling;Jiao Weiping;Wu Yingfeng;Zhang Chen;Qiu Yelong;Han Youli(Xuanwu Hospital Capital Medical University,Beijing 100053,China;School of Public Health,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学宣武医院,北京100053 [2]首都医科大学公共卫生学院,北京100069

出　　处：《中华医院管理杂志》2020年第2期108-112,共5页Chinese Journal of Hospital Administration

基　　金：国家自然科学基金(71774113)。

摘　　要：目的以脑梗死作为切入点,研究主要诊断的选择对疾病诊断相关分组(diagnosis-related groups,DRG)入组和权重变化的影响。方法选择某医院2019年1月1日至2019年3月31日,主要诊断为脑梗死的3个DRG组(BR25、BR23、BR21)331例患者资料。原始入组情况作为对照组;将主要诊断与第一其他诊断进行互换,其他变量不进行变化,再进行DRG入组,该组作为实验组。对两组的入组与权重变化进行分析。结果有41.4%(137/331)的实验组DRG入组BZ11神经系统其他疾患伴重要合并症与伴随病,82.5%(273/331)的患者经过转换诊断后权重升高。结论选择其他诊断作为主要诊断可能会改变疾病的权重,影响相应的疾病给付。为防止高码低编,应细化DRG分组,DRG支付要考虑如何体现出疑难病例的价值;对于低码高编行为,医保中心及相关医疗机构应进行编码正确性的核查,监察到位。Objective To study the influence of the choice of main diagnosis on diagnosis-related groups(DRG)grouping and weight change,by taking cerebral infarction as the entry point.Methods From January 1,2019 to March 31,2019,331 patients in three DRG groups(BR25,BR23,BR21)with cerebral infarction were selected.The original group was used as the control group;the main diagnosis was exchanged with the first other diagnosis,then DRG group was used as the experimental group.The difference of the number of cases and weight between the two groups was analyzed.Results 41.4%(137/331)of the patients in the experimental group were enrolled in BZ11 with other neurological disorders associated with important comorbidities and comorbidities,and 82.5%(273/331)patients′weight increased after diagnostic conversion.Conclusions Choosing other diagnosis as the main diagnosis may change the weight of the disease and affect the corresponding disease benefit.In order to prevent downcoding,DRG grouping should be detailed,and DRG payment should consider how to reflect the value of difficult cases;for upcoding behavior,medical insurance center and relevant medical institutions should check the correctness of coding,and monitor in place.

关 键 词：疾病诊断相关分组 主要诊断选择 低码高编 高码低编 

分 类 号：R74[医药卫生—神经病学与精神病学]