基于C-DRG收付费模式的患者出院流程设计实践探索  

The practice of the patient discharge process design based on the C-DRG charging and payment mode

作　　者：颜玉炳 徐航[1] Yan Yubing;Xu Hang(Zhongshan Hospital,Xiamen University,Xiamen 361004,Fujian Province,China)

机构地区：[1]厦门大学附属中山医院,福建厦门361004

出　　处：《中国数字医学》2022年第4期74-77,94,共5页China Digital Medicine

基　　金：厦门市科技计划项目(3502Z20209038)。

摘　　要：目的:设计一套适合C-DRG收付费模式的患者出院流程。方法:对C-DRG收付费模式下院内系统、DRG分组系统和医保结算系统的多项业务数据流进行梳理,对整体出院流程进行再造,在此基础上,运用PDCA方法对数据上传、出科和数据作废等流程进行不断优化。结果:该出院流程在试点医院运行顺畅,相关数据质检和校验全部在系统后台执行,医护人员实际操作的体验感较好,出院流程设计满意度达96%;正式运营后的120天,病案首页填写完整率达100%,数据上传成功率达99.5%,入组率达92.1%,整体DRG结算率达62.8%,出院办理平均等待时间和既往相比基本持平。结论:C-DRG收付费模式对医疗机构信息系统改造要求较高,应在顶层设计上严格把控。Objective To design a set of patient discharge process suitable for C-DRG charging and payment mode.Methods The multiple business data flows of the hospital system,DRG grouping system and medical insurance settlement system under the C-DRG charging and payment mode were sorted out,and the overall discharge process was reconstructed.On this basis,PDCA method was used to continuously optimize the processes such as data upload,leaving the department and data cancellation.Results The discharge process was operated smoothly in the pilot hospital.The quality inspection and verification of related data were all executed in the background of the system.The medical staffs had a good sense of experience in the actual operation,and the satisfaction with the discharge process design was 96%;and 120 days after the official operation,the completion rate of the first page of the medical record was 100%,the success rate of data upload was 99.5%,the enrollment rate was 92.1%,and the overall DRG settlement rate was 62.8%.The average waiting time for discharge was basically the same as before.Conclusion The C-DRG charging and payment mode has high requirements for the information system reform of medical institution,which should be strictly controlled in the top-level design.

关 键 词：疾病诊断相关分组 出院流程 信息系统 

分 类 号：R197.323[医药卫生—卫生事业管理]