疾病诊断相关分组背景下日间手术病例结算清单质量管理经验介绍  

Introduction to quality management experience of settlement checklist for day surgery cases under the background of diagnosis-related groups

作　　者：夏锋 夏燕[1] XIA Feng;XIA Yan(Medical Insurance Office,the Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou,Zhejiang 310000,P.R.China)

机构地区：[1]浙江大学医学院附属第二医院医疗保险办公室,杭州310000

出　　处：《华西医学》2024年第2期304-307,共4页West China Medical Journal

基　　金：浙江省康恩贝医院管理软科学研究项目(2022ZHA-KEB101)。

摘　　要：该文以浙江大学医学院附属第二医院乳腺外科为例,介绍了日间手术病例结算清单质量管理经验。该院通过建立疾病诊断相关分组(diagnosis-related groups, DRG)结算清单质量控制审核机制,引入DRG信息系统实时监测结算清单质量,加强低倍率病例监管等措施,有效提升了医疗保险基金结算清单质量和病例入组准确性,减少了低倍率病例的发生。从医院整体上,日间手术和DRG支付方式共同促进了医疗服务效率的有效提升以及医疗资源的合理分配,降低了患者均次费用和平均住院日。Taking the Breast Surgery Department of the Second Affiliated Hospital Zhejiang University School of Medicine as an example,this paper introduces the quality management experience of day surgery case settlement checklist.Through the establishment of diagnosis-related groups(DRGs)settlement checklist quality control review mechanism,the introduction of DRGs information system to monitor the quality of settlement checklist in real time,and strengthening the supervision of low-rate cases and other measures,the quality of medical insurance fund settlement checklist and the accuracy of case enrollment have been effectively improved,and the occurrence of low-rate cases has been reduced.On the whole,day surgery and DRGs payment jointly promote the effective improvement of medical service efficiency and the reasonable allocation of medical resources,and reduce the average cost per patient and the average length of hospital stay.

关 键 词：日间手术 疾病诊断相关分组 结算清单 

分 类 号：R197.323[医药卫生—卫生事业管理]