首页编码质控对DIP病种分值的影响  

Effective of the Front Page’s Diagnostic Codes Quality Control on DIP Disease Scores

作　　者：陈菠 CHEN Bo(Department of Quality Management,Women and Children’s Hospital,School of Medicine,Xiamen University,Xiamen Fujian 361003,China)

机构地区：[1]厦门大学附属妇女儿童医院/厦门市妇幼保健院质量管理部,福建厦门361003

出　　处：《中国卫生标准管理》2023年第19期9-12,共4页China Health Standard Management

摘　　要：目的探讨按病种分值付费(diagnosis-intervention packet,DIP)实施下的病案首页编码质控对于提高诊断手术填写正确、疾病编码准确,保障病种正确入组、合理反映DIP病种分值的重要作用。方法分析厦门某三甲医院2022年1—12月首页编码质控中存在问题的病历1838份,比较编码质控前后以及不同质控问题类型下的DIP病种分值、科室分值以及分值类型之间的关系。结果首页编码质控前后在病种权重RW均值、病种平均分值比较,差异均有统计学意义(P<0.05)。产科、妇科、儿内科、新生儿科问题病历质控前后病种分值比较,差异有统计学意义(P<0.05)。错填主诊断、错填主手术、错编主诊断以及漏填手术等4类质控问题对病种分值的影响差异有统计学意义(P<0.05)。结论遵循“临床规范诊疗与首页真实完整记录、编码员按照编码原则准确编码、医保按DIP合理入组”的原则基础上加强诊断首页编码质控工作,“减少失分”,提高首页诊断手术填写正确率、编码准确率,获得合理的医保基金结算差额,充分发挥医保按病种分值付费的改革作用,促进医疗机构长远发展。Objective To explore the importance of the quality control of diagnostic codes on the front page of medical records under the implementation of payment according to disease score is discussed to improve the correct filling of diagnostic surgery,accurate disease coding,ensure the correct enrollment of diseases,and reasonably reflect the score of diagnosis-intervention packet(DIP).Methods A total of 1838 medical records with diagnostic code quality control problems in a tertiary hospital in Xiamen from January to December,2022 were analyzed,and the relationship between the disease score,department score,and score type was compared before and after the code quality control and under different types of quality control problems.Results Before and after coding quality control,there were statistically significant differences in the mean RW of disease weight and the average score of disease(P<0.05).The study found that there were statistically significant differences in the scores of obstetric,gynecology,pediatrics,neonatology and other medical records before and after quality control(P<0.05).Misfilled primary diagnosis and surgery,error coding for the primary diagnosis and missed surgery which impact the quality control problems on disease scores were statistically significant(P<0.05).Conclusion Following the principle of"clinical standard diagnosis and treatment and the true and complete records of the front page,the coders accurately coded according to the coding principles,and the medical insurance is reasonably included in the group according to the DIP",the quality control of diagnostic coding is strengthened on the basis of"reducing points lost",and the correct rate of diagnostic operations on the front page is improved.Accuracy of coding,obtaining a reasonable settlement balance of medical insurance funds,giving full play to the role of medical insurance in the reform of payment by disease type,and promoting the long-term development of medical institutions.

关 键 词：按病种分值付费 首页编码质控 ICD编码 质量控制 住院病案首页 医保结算 

分 类 号：R197[医药卫生—卫生事业管理]