医院DRG运营管理系统设计与应用  

Design and Application of Hospital DRG Operation Management System

作　　者：熊尚华 郭佳奕[1] 颜梅[1] 郑盼 黄玉清 XIONG Shanghua;GUO Jiayi;YAN Mei;ZHENG Pan;HUANG Yuqing(Jinhua Municipal Central Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]金华市中心医院,浙江省金华市321000

出　　处：《中国卫生信息管理杂志》2024年第2期240-245,251,共7页Chinese Journal of Health Informatics and Management

基　　金：浙江省医药卫生科技计划项目“基于病组点数法医保支付方式的DRGs对医院综合能力评价及绩效考核的应用研究”(2020KY1011);金华市公益性技术应用研究项目“基于医疗大数据的医院监测分析平台构建”(2022-4-127)。

摘　　要：目的设计一种交互性好、可用性高、扩展性强的疾病诊断相关分组(DRG)运营管理系统,为医院具体实施DRG付费和医疗服务绩效评价提供信息化支撑。方法通过研究DRG管理工具,从系统架构、数据管理、指标体系、系统功能4个方面提出医院DRG运营管理系统的设计思路,结合联机分析处理、数据挖掘、可视化等技术,实现医院运营数据的多维联机分析和内涵挖掘。结果实现了医保合理控费、临床路径管理、医疗服务绩效评价三大场景管理应用,相较2020年,2021年平均住院日下降0.5天,住院均次费用下降526.88元。结论在满足国家、省、市三级DRG管理体系建设要求的基础上,融合了DRG付费和医疗服务绩效评价的一体化运营管理,实现了医疗服务质量和医疗资源合理消耗的均衡发展。Objective A DRG operation management system with good interactivity,high availability and strong scalability is designed to provide information support for hospitals to implement DRG payment and medical service performance evaluation.Methods Through the research of DRG management tools,this study puts forward the design idea of hospital DRG operation management system from four aspects of system architecture,data management,index system and system function and realizes multi-dimensional online analysis and data mining of hospital operation data combining with online analytical processing,data mining and visualization.Results It has realized the management application of three application scenarios of reasonable cost control of medical insurance,clinical path management,medical service performance evaluation,compared with 2020,the average hospitalization day in 2021 decreased by 0.5 days,and the average hospitalization cost decreased by 526.88 yuan.Conclusion On the basis of meeting the requirements of national,provincial and municipal DRG management systems construction,the integrated operation management of DRG payment and medical service performance evaluation is integrated to achieve the balanced development of medical service quality and reasonable consumption of medical resources.

关 键 词：医院运营管理 DRG付费 医疗服务绩效评价 微服务架构 

分 类 号：R-058[医药卫生] R197.3