精益管理模式对病案归档和终末质量的影响  

Study on the Impact of Lean Management Mode on Medical Record Filing and Terminal Quality

作　　者：章霞 曾丹丹 柯乃绮 林明色[1] 方浩[1] Zhang Xia;Zeng Dandan;Ke Naiqi;Lin Mingse;Fang Hao(Zhongshan Ophthalmic Center of Sun Yat-Sen University,Guangzhou 510060,Guangdong Province,China;不详)

机构地区：[1]中山大学中山眼科中心,广东省广州市510060

出　　处：《中国病案》2022年第6期12-15,共4页Chinese Medical Record

摘　　要：目的 探索病案的精益管理模式,提高病案归档率和病案质量,助力按病种分值付费和三级公立医院绩效考核。方法 精益管理模式实施前,2017年4月1日-2017年6月30日的病案作为对照组,精益管理模式实施后,2021年4月1日-2021年6月30日的病案作为实验组。从某院病案管理系统、住院信息系统中提取病案归档、质检和质量评价数据。采用卡方检验比较病案3日归档率、返修率、甲级率和住院病案首页准确率。结果 对照组病案归档10905份,质检4082份,质量评分1602份。实验组病案归档12312份,质检11239份,质量评分3717份。病案精益管理模式实施后,3日归档率由20.83%升至99.83%,返修率由23.71%降至10.46%,甲级率由97.50%升至99.70%,住院病案首页准确率由85.06%升至95.36%。差异均有统计学意义(P<0.001)。结论 病案精益管理可显著提高病案归档率和病案质量,可为按病种分值付费和三级公立医院绩效考核提供数据保障。Objectives To explore the lean management mode of medical records to improving the filing rate and quality of medical records,which could assist the implementation of DIP(Diagnosis-Intervention Packet),and improve the quality of performance assessment data in tertiary public hospitals.Methods The medical records which from April 1st to June 30th,2017 before lean management implementation as control group,and the medical records which from April 1st to June 30th,2021 after lean management implementation as experimental group.The data of medical record filing,quality inspection and quality evaluation were extracted from the medical record management system and hospital information system.Chi-square test was made to determine the differences of the 3-day filing rate,medical record repaired,the rate of grade A medical record and the accuracy rate of home page before and after lean management.Results In the control group,10905 medical records were filed,4082 were inspected,and 1602were quality evaluation.In the experimental group,12312 medical records were filed,11239 were inspected,and 3717 were quality evaluation.After implementation of lean management,the 3-day filing rate increased from 20.83% to 99.83%,the rate of medical record repaired decreased from 23.71% to 10.46%,the rate of grade A medical record increased from 97.50% to 99.70%,and the accuracy rate of home page increased from 85.06% to 95.36%.The differences were statistically significant(P<0.001).Conclusions The implementation of the lean management in the medical record department was so helpful and desirable.It could provide an adequate data guarantee for DIP and performance assessment of tertiary public hospitals.

关 键 词：精益管理模式 归档率 按病种分值付费 病案管理 

分 类 号：R197.323[医药卫生—卫生事业管理]