C-DRG与DIP多元医保支付模式下病案首页双数据存储模式设计与实践  

Design and Practice of Double Data Storage Model on the Front Pages of Medical Record Under C-DRG and DIP Multiple Medical Insurance Payment Mode

作　　者：颜玉炳 徐航[1] 曹莎莉 YAN Yubing;XU Hang;CAO Shali(Zhongshan Hospital Xiamen University,Xiamen 361004,Fujian,China)

机构地区：[1]厦门大学附属中山医院,福建省厦门市361004 [2]厦门市病案管理质量控制中心,福建省厦门市361004

出　　处：《中国卫生信息管理杂志》2023年第4期605-609,615,共6页Chinese Journal of Health Informatics and Management

基　　金：厦门市科技计划项目“多元复合医保支付方式下病种超额费用控制路径研究”(项目编号:3502Z20209038)。

摘　　要：目的在以C-DRG收付费模式为主、DIP模式为辅的多元医保支付模式下,设计一套合适的病案首页数据存储模式。方法对C-DRG收付费模式和DIP模式的业务流程进行梳理,采用病案首页双数据存储模式设计以适应多元医保支付要求,其中医生版病案首页用于C-DRG分组与结算,病案室版病案首页用于传统病案首页数据上报和医保结算清单数据来源。结果病案首页双数据存储模式设计不仅可以满足C-DRG收付费模式的要求,而且继续保留了传统病案首页的内容,适用性较好。升级后的诊断填写与同步功能确保了病历文书中所有诊断填写的一致性,缩短了病历诊断的填写时间,极大地提高了临床医生的工作效率。结论C-DRG与DIP多元医保支付模式下病案首页双数据存储模式适用性强。Objective To design a data storage model on the front pages of medical record which is suitable for the multiple medical insurance payment mode dominated by C-DRG mode and supplemented by dip mode.Methods By Sorting out the processes of C-DRG mode and dip mode,double data storage model on front page of medical record was adopted to meet the payment requirements of multiple medical insurance.The front page of doctor version was used for C-DRG grouping and settlement,and the front page of medical record room version was used for data reporting and the data source of medical insurance settlement list.Results The double data storage model on front page of medical record could not only meet the requirements of C-DRG mode,but also continue to retain the content of the traditional front page of medical records.The upgraded diagnosis filling and synchronization function could ensure the consistency of all diagnosis filling in the medical record document and shorten the filling time of medical record diagnosis which greatly improve the work efficiency of clinicians.Conclusion Under C-DRG and dip multiple medical insurance payment mode,the design of double data storage model on front pages of medical record has strong applicability which was worth popularizing.

关 键 词：按疾病诊断相关分组 按病种分值付费 病案首页 数据存储 

分 类 号：R-058[医药卫生] R197.3