按病种分值付费亏损病案入组影响因素分析  

Influencing factors of the inclusion of deficit medical records under the diagnosis-intervention packet

作　　者：马迎丽 Ma Yingli(Medical Record Management Office,Binzhou Medical University Hospital,Binzhou 256600,China)

机构地区：[1]滨州医学院附属医院病案管理办公室,山东滨州256600

出　　处：《中国医院统计》2023年第4期281-284,共4页Chinese Journal of Hospital Statistics

摘　　要：目的探讨按病种分值付费(DIP)下亏损病案入组影响因素。方法回顾性研究某三级公立医院2022年1—6月21436份亏损病案的病案首页内容,分析DIP入组的影响因素。结果亏损病案类型以正常倍率组最多,占84.27%;医疗保险类型以居民医保最多,占87.45%;亏损病案数量以儿科最多,占9.00%,消化内科位于第2位,占8.31%。在DIP亏损病案的入组影响因素中,DIP分组器分组错误占33.08%,药物、耗材、检验检查费用偏高占15.05%,主要诊断编码错误占12.57%,入组正确但病种分值偏离实际占8.48%,主要手术编码错误占3.09%,其他占27.73%。结论医疗机构、医保部门需加强与第三方软件开发公司合作与沟通;病案编码员编码时,避免盲目地从计算机检索编码,应按照编码规则准确编码;医疗机构应加强临床行为管控,促进合理诊疗,合理控制医疗资源和成本。Objective To explore the influencing factors of the inclusion of the deficit medical records under the diagnosis-intervention packet(DIP).Methods A retrospective study was conducted on the home page contents of 21436 deficit medical records in a tertiary public hospital from January to June 2022,and the influencing factors of DIP inclusion were analyzed.Results The most type of deficit medical records was the normal rate group,accounting for 84.27%.The type of medical insurance was medical insurance for residents,accounting for 87.45%.The number of deficit medical records was the the largest in the department of pediatrics,accounting for 9.00%,and the department of gastroenterology was the second,accounting for 8.31%.Among the factors influencing of the inclusion of deficit medical records under DIP,DIP grouping error accounted for 33.08%,high cost of medicine,medical consumables and inspection accounted for 15.05%,major diagnosis coding error accounted for 12.57%,correct inclusion with disease type score deviation accounted for 8.48%,and major surgical coding error accounted for 3.09%.Others accounted for 27.73%.Conclusion Medical institutions and medical insurance departments should strengthen cooperation and communication with third-party software development company.When coding,the medical record coders should avoid blindly retrieving the codes from computers,and code accurately according to coding rules.Medical institutions should strengthen clinical behavior control,promote rational diagnosis and treatment,and reasonably control medical resources and costs.

关 键 词：病案首页 病案编码员 按病种分值付费 

分 类 号：R197.1[医药卫生—卫生事业管理]