病案信息技术人员在提升DRG入组准确率上的策略及对医疗系统的影响  

Strategies of Medical Record Information Technicians in Improving the Accuracy Rate of DRG Grouping and Its Impact on the Medical System

作　　者：于晓蕾 刘修凤 杨柳 杨松 华锦霞 耿光镇 龚宏印 张逸尘 YU Xiaolei;LIU Xiufeng;YANG Liu;YANG Song;HUA Jinxia;GENG Guangzhen;GONG Hongyin;ZHANG Yichen(Department of Medical Affairs,Shougang Shuigang Hospital,Liupanshui Guizhou 553028,China)

机构地区：[1]首钢水钢医院医务部,贵州六盘水553028

出　　处：《中国卫生标准管理》2024年第16期7-10,共4页China Health Standard Management

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2022-281)。

摘　　要：在当前卫生健康体系中,诊断相关分组(diagnosis related groups,DRG)支付模式被越来越多的国家采纳以促进医疗服务效率和质量的提升。然而,实施DRG系统的一个关键挑战是确保高准确率的病历入组,因为这直接关系医疗机构的收入与成本控制。文章聚焦于病案信息技术人员在提高DRG入组率中的作用,探讨如何通过精准编码和数据管理提升DRG系统的效率和准确性。采用了定性研究和定量分析相结合的方法,首先通过文献回顾和专家访谈收集了关于病案信息技术人员职责与DRG系统要求的信息;然后,通过案例分析评估了病案信息技术人员在实际工作中如何识别、记录和处理影响DRG入组率的关键因素;最后,运用统计分析方法对不同干预措施的效果进行了量化评估。揭示病案信息技术人员在数据质量控制、编码准确性以及信息技术应用方面如何作用于DRG系统性能的提升。研究发现,病案信息技术人员的专业能力对于提高DRG入组率至关重要。通过精确的疾病和手术编码、及时的数据捕获以及对不一致或缺失信息的纠正,可以显著减少错误入组的情况。此外,采用先进的信息技术工具和算法可以进一步提高编码效率和准确性。跨学科合作和持续培训能够有效增强病案信息技术人员在DRG系统中的作用。文章强调了病案信息技术人员在优化DRG支付系统中的核心作用,并指出通过提升他们的专业能力和利用信息技术手段,可以显著提高DRG系统的入组准确率。这一发现对于卫生管理者和政策制定者来说具有重要价值,不仅有助于提高医疗服务质量和患者满意度,还能确保医疗资源的合理分配和利用。In the current health care system,the diagnosis related groups(DRG)payment model has been adopted by more and more countries to promote the improvement of medical service efficiency and quality.However,a key challenge in implementing the DRG system is to ensure a high accuracy rate of case grouping,as this is directly related to the revenue and cost control of medical institutions.This paper focuses on the role of medical records information technology personnel in improving the DRG enrollment rate,and discusses how to improve the efficiency and accuracy of DRG system through accurate coding and data management.The method of qualitative research and quantitative analysis is adopted.Firstly,through literature review and expert interview,the information about the responsibilities of medical records information technicians and the requirements of DRG system is collected.Then,through case analysis,the paper evaluates how medical records information technicians identify,record and deal with the key factors affecting the DRG enrollment rate in practical work.Finally,statistical analysis methods were used to quantitatively assess the effects of different intervention measures.The focus of the study is to reveal how medical record information technicians contribute to the improvement of the DRG system's performance in terms of data quality control,coding accuracy,and information technology application.The study found that the professional ability of medical record information technicians is crucial for increasing the DRG grouping rate.Through precise disease and surgical coding,timely data capture,and the correction of inconsistent or missing information,the situation of incorrect grouping can be significantly reduced.In addition,the adoption of advanced information technology tools and algorithms can further improve coding efficiency and accuracy.Interdisciplinary cooperation and continuous training can effectively enhance the role of medical record information technicians in the DRG system.The paper emphasizes the core

关 键 词：诊断相关分组 病案信息技术 编码准确性 跨学科合作 培训体系 病案信息技术应用 

分 类 号：R197[医药卫生—卫生事业管理]