基于HIS病种诊疗小目录的DRG主诊断选择辅助支持功能的设计与实现  

Design and Implementation of Intelligent Support Function for DRG Main Diagnosis Selection Based on HIS Disease and Treatment Small Catalogue

作　　者：王兴强 徐茂云 WANG Xingqiang;XU Maoyun(Department of Health Economics,The 960th Hospital of PLA Joint Logistics Support Force,Jinan Shandong 250031,China;Department of Quality Management,The 960th Hospital of PLA Joint Logistics Support Force,Jinan Shandong 250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六○医院卫生经济科,山东济南250031 [2]中国人民解放军联勤保障部队第九六○医院质量管理科,山东济南250031

出　　处：《中国医疗设备》2024年第1期79-84,91,共7页China Medical Devices

基　　金：国家自然科学基金(81502896)。

摘　　要：目的 针对多病种治疗条件下临床医生选择疾病诊断相关分组(Diagnosis Related Groups,DRG)主诊断困难的问题,基于病种诊疗小目录技术实现DRG主诊断选择辅助决策支持功能,提高DRG主诊断选择的准确性。方法 建立病种诊疗小目录和病种价表小目录,将病种与诊疗项目和价表项目分别做对照。创建数据库医嘱表和费用明细表的触发器,实现患者目录内诊疗数据和费用数据的采集,再通过WebService服务实现病种治疗费用和病种治疗时间的排序,为临床医生提供DRG主诊断选择辅助支持。比较系统使用前后主诊断准确率、病案归档时间及超地区病种平均费用的差异。结果 系统使用后,病案主诊断错误率由11.5%降到3.0%,病案归档时间由(3.34±1.77)d缩短至(3.13±1.60)d,患者费用超地区病种平均费用由(1508.85±10355.77)元降低至(506.68±10385.09)元,降低66.42%,且差异均具有统计学意义(P﹤0.05)。结论 该功能为临床医生提供“消耗医疗资源最多”和“影响住院时间最长”两个要素的定量数据,可以提高DRG主诊断选择的准确性和实时性。Objective In response to the difficulty of selecting diagnosis related groups(DRG)as the main diagnosis for clinical doctors under multiple disease treatment conditions,to implement the auxiliary decision support function for DRG main diagnosis selection based on the disease diagnosis and treatment small directory technology,and to improve the accuracy of DRG main diagnosis selection.Methods A small catalogue of disease and treatment and a small catalogue of disease and price were established,and the disease with the treatment items and price items respectively was compared.The triggers for the doctor’s order list and price list in the database was created to realize the collection of treatment data and price data in the patient catalogue,and then the disease treatment costs and treatment time was sorted through WebService services,which could provide DRG main diagnosis selection assistance support for clinical doctors.The accuracy rate of main diagnosis,the filing time of medical records and the average cost of patients exceeding the regional disease category were compared before and after using the system.Results After the application of the system,the main diagnostic error rate of medical records decreased from 11.5%to 3.0%,the filing time of medical records decreased from(3.34±1.77)d to(3.13±1.60)d,and the average cost of patients exceeding the regional disease category decreased from(1508.85±10355.77)yuan to(506.68±10385.09)yuan,with a decrease of 66.42%.The differences were statistically significant(P<0.05).Conclusion This function provides clinicians with quantitative data on the two elements of“consuming the most medical resources”and“affecting the longest hospital stay”,which can improve the accuracy and real-time performance of providing auxiliary support for the selection of primary diagnosis for DRG.

关 键 词：医院信息系统 疾病诊断相关分组 主诊断 诊疗项目 病种目录 

分 类 号：R197.324[医药卫生—卫生事业管理]