基于DRG的排除病例数据分析及改进探索  

Data Analysis and Improvement Exploration of Excluded Cases Based on DRG

作　　者：杨伯钊[1] 张罗[1] 王古岩 魏文斌[1] YANG Bo-zhao;ZHANG Luo;WANG Gu-yan(Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing,100730,China;不详)

机构地区：[1]首都医科大学附属北京同仁医院,北京100730

出　　处：《中国医院管理》2021年第9期48-52,56,共6页Chinese Hospital Management

摘　　要：目的分析某医院近3年的排除病例数据,为疾病诊断相关分组精细化管理提供指导和借鉴。方法统计并分析某院2017年1月—2019年12月间全部排除病例的数据,比较不同类型排除病例的分布及构成,并对部分类型排除病例的原因进行探索性研究。结果排除病例中最主要的类型是歧义(QY)病例,R组歧义(RQY)病例在各年度中均为最多。住院超60天的病例严重影响病床周转,其总费用及例均费用均明显高于QY病例。手术及操作类病组与内科类病组间的入组原则不同,内科病组与QY组间在操作编码兼容性上具有优先级规律。结论不同类型排除病例的产生原因迥异,需分别探索管理策略。QY病例作为一个特殊分组结果,受到主要诊断、手术操作编码、分组方案的共同影响,但与其质量内涵无关。临床科室应结合各学科特点来科学地设置临床路径及诊疗方案,并推荐借助大数据平台的优势对QY病例进行多部门联合管理。Objective To analyze the data of excluded cases in general hospital in recent 3 years,to provide guidance and references for the fine management of DRG.Methods The data of all excluded cases in general hospital from January 2017 to December 2019 were statistically analyzed,and the distribution and composition of different types of excluded cases were compared,and the reasons for some types of excluded cases were explored.Results The main type of excluded cases was QY cases and RQY cases were the most in each year.The cases with hospitalization time over 60 days seriously affect the turnover of hospital beds,the total cost and average cost of those cases were significantly higher than those of QY cases.There are different principles of joining the group between operation group and internal medicine group,and there is a priority rule between internal medicine group and QY group in operation code compatibility.Conclusion The causes of different types of excluded cases are quite different,and the management strategies should be explored respectively.QY cases as a special grouping result,QY cases are affected by the main diagnosis,operation code,and grouping scheme,but it has nothing to do with the quality connotation.Clinical departments should scientifically set up clinical pathways and diagnosis and treatment schemes according to the characteristics of various subjects,and recommend multi-department joint management of QY cases with the advantage of a big data platform.

关 键 词：疾病诊断相关分组 排除病例 歧义病例 分组方案 

分 类 号：R197.323.2[医药卫生—卫生事业管理]