基于动态分组器的DRG智慧管理系统设计与应用  

Design and Application of DRG Intelligent Management System Based on Dynamic Grouping Device

作　　者：车滢霞 杨科春[2] 秦锡虎 汤黎明[3] 陈强[1] 郑晓渊[1] CHE Yingxia;YANG Kechun;QIN Xihu;TANG Liming;CHEN Qiang;ZHENG Xiaoyuan(Information Center,Changzhou Second People’s Hospital,Changzhou Jiangsu 213000,China;Office of Medical Insurance,Changzhou Second People’s Hospital,Changzhou Jiangsu 213000,China;Office of Hospital,Changzhou Second People’s Hospital,Changzhou Jiangsu 213000,China)

机构地区：[1]常州市第二人民医院信息科,江苏常州213000 [2]常州市第二人民医院医保办,江苏常州213000 [3]常州市第二人民医院院办公室,江苏常州213000

出　　处：《中国医疗设备》2023年第3期89-94,共6页China Medical Devices

基　　金：江苏省2021年度加强公立医院绩效考核工作专项研究课题(JSYGY-1-2021-PJ32)。

摘　　要：目的解决传统疾病诊断相关分组(Diagnosis Related Groups,DRG)管理模式存在的质控滞后、无法支撑智能化分组等问题,从而实现DRG智慧管理。方法基于标准化医疗术语对电子病历进行全结构化改造,并通过规则引擎实现病案全流程DRG质控,动态分组器实时抓取诊疗过程中的诊断、手术及操作等,结合医保反馈数据,指导临床动态分组及事后追溯分析,并使用报表技术、数据挖掘技术等构建数据分析体系。结果系统应用后,病例组合指数提升了14.87%,时间消耗指数下降了6.38%,费用消耗指数下降了1.88%,DRG组数增加了1.84%,次均费用下降4.09%,结付率提高了8.78%,并且提高了病历质量及患者满意度。结论系统在提升临床能力、工作效率、医疗服务质量,减轻患者负担,规范医疗行为,助力医院精细化管理等方面均具有显著作用。Objective To solve the problems of quality control lag and inability to support intelligent diagnosis related grouping(DRG)in the traditional DRG management mode,so as to realize intelligent DRG management system.Methods Electronic medical record were fully modified based on standardized medical terms,DRG quality control for the whole process of medical records was conducted through the rule engine.The dynamic grouping device captured the diagnosis,surgery or operation in the diagnosis and treatment process in real time,then combined them with the historical medical insurance feedback data,which could guide the clinical staff in dynamic grouping and post event retrospective analysis.Finally,data analysis system using report technology and data mining technology were constructed.Results After the application of the system,the case-mix index increased by 14.87%,the time consumption index decreased by 6.38%,the cost consumption index decreased by 1.88%,the number of DRG groups increased by 1.84%,the average cost per time decreased by 4.09%,the settlement rate increased by 8.78%.And the quality of medical records and patient satisfaction were improved.Conclusion The system plays a significant role in improving clinical ability,work efficiency,medical service quality,reducing the burden on patients,standardizing medical behavior and helping the hospital with refined management.

关 键 词：DRG 智慧管理 动态分组器 全流程质控 

分 类 号：R197.324[医药卫生—卫生事业管理]