哈尔滨市医疗机构DRG模拟运行中发现的问题及解决措施探讨  

Discussion on the Problems and Solutions of DRG Simulation Operation in Harbin Medical Institutions

作　　者：李会玲[1] 曹蕊[1] 许凤娟[1] 蔡秀芝[2] 王大鹏[3] LI Hui-ling;CAO Rui;XU Feng-juan(The First Hospital of Harbin Medical University,Harbin,Heilongjiang,150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001 [2]哈尔滨市疾病预防控制中心,黑龙江哈尔滨150056 [3]哈尔滨医科大学附属肿瘤医院,黑龙江哈尔滨150081

出　　处：《中国医院管理》2021年第8期63-65,68,共4页Chinese Hospital Management

摘　　要：目的 DRG付费模式势在必行,通过对57家试点医疗机构历史病案数据进行分组模拟测试,发现问题,明确问题的解决措施。方法对黑龙江省哈尔滨市57家试点医疗机构2016年1月—2019年9月历史病案及结算数据中获取相关信息进行分组测算,运用数理统计法归纳分组测试结果。结果通过DRG分组模拟运行,发现的问题有病案首页数据质量填写、编码校验、分组器设置、信息化建设。结论黑龙江省DRG付费模式顺利推广需要加强病案首页书写,提高病案编码的质量,完善分组器,加强信息化管理平台建设,旨在为黑龙江省DRG付费模式顺利实施奠定坚实基础,提供科学的指导建议。Objective DRG payment mode is imperative.Through the simulation test on the historical medical record data of 57 sample hospitals,to find the problems and to make clear the solution.Methods Calculating the data of the relevant information obtained from the historical medical records and settlement data of 57 pilot medical institutions in Harbin City,Heilongjiang Province from January,2016 to September,2019.Using the mathematical statistics to sum up problems.Results Through DRG grouping simulation,it is found that the problems included data filling in the first page of medical record,code checking,grouping device setting,and information construction.Conclusion In order to provide scientific guidance suggestion for the smoothl generalization of DRG payment mode in Heilongjiang Province,it is necessary to improve the writing quality of the first page of medical records,improve coding quality,perfect grouping device and strengthen information management platform construction.

关 键 词：疾病诊断相关分组 医疗机构 病案 

分 类 号：R197.1[医药卫生—卫生事业管理]