基于商业智能技术的DRG分析系统构建与实践  

Construction and practice of DRG analysis system based on business intelligence technology

作　　者：张伟[1] 陈登菊[1] 杨巧[1] 符美玲[1] 吕富荣[1] ZHANG Wei;CHEN Dengju;YANG Qiao;FU Meiling;LYU Furong(Medical Insurance Office,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院医保办,重庆400016

出　　处：《中国数字医学》2023年第2期16-20,46,共6页China Digital Medicine

基　　金：重庆市卫生健康委医学科研项目(2023WSJK023)。

摘　　要：目的:基于商业智能技术构建DRG智能分析系统,可视化展示DRG运行过程中的关键节点,使医院管理者更全面便捷的了解现状。方法:以DRG付费运营管理链核心特征和关键节点为基础,运用漏斗模型、RFM模型、波士顿矩阵图、ABC模型、用户画像等数据分析模型,结合数据仓库、联机分析、数据挖掘、数据可视化等商业智能技术构建DRG智能分析系统;分析系统在DRG入组、结算清单上传、DRG结算、成本控制、病组策略及自助化分析等的应用场景。结果:2022年初DRG智能分析系统上线,我院入组率从2021年1月的92.89%提升到2022年11月的99.67%;结算清单10日上传率明显上升;每权重次均费用降低近1 000元,费用指数降低20.91%,CMI得到持续提升。结论:基于商业智能技术构建可视化DRG智能分析系统,可控制医疗成本,提升医疗效率,优化病种结构,助力医院在DRG支付改革及医疗管理中便捷高效做出科学决策,提高医院整体运营效率。Objective To build a DRG intelligent analysis system based on business intelligence technology,visualize the key links in DRG operation process,and help hospital managers understand the status quo more comprehensively and conveniently.Methods Based on the core features and key links of DRG payment operation management chain,the DRG intelligent analysis system was constructed by applying data analysis models such as funnel model,RFM model,Boston matrix graph,ABC model,user portrait,etc.,and applying business intelligence technologies such as data warehouse,online analysis,data mining,data visualization and others.The application scenarios of the system in DRG grouping,billing list uploading,DRG settlement,cost control,disease group strategy and self-service analysis were analyzed.Results The DRG analysis system was launched in early 2022,the enrollment rate of our hospital increased from 92.89%in January 2021 to 99.67%in November 2022.The 10-day upload rate of billing list increased significantly.The average cost per weight was reduced by nearly 1000 CNY,the cost index was reduced by 20.91%,and the CMI was continuously improved.Conclusion Building a visual DRG intelligent analysis system based on business intelligence technology can not only control medical costs,improve medical efficiency,optimize the structure of diseases,but also help hospitals make scientific decisions conveniently and efficiently in DRG payment reform and medical management,and improve the overall operating efficiency of hospitals.

关 键 词：商业智能技术 疾病诊断相关分组 数据模型 智能分析 

分 类 号：R-056[医药卫生]