DRG付费下病案编码员的可能行为分析与聚类研究  

Cluster analysis on Medical Records Coder's Possible Behavior in DRG Payment

作　　者：付映宏 高广颖[1] 代珊珊 蔡心雨 田佳帅 张婧怡 张礼亮 Fu Yinghong;Gao Guangying;Dai Shanshan(Capital Medical University Yanjing Medical College,Beijing,101300,China;不详)

机构地区：[1]首都医科大学公共卫生学院,北京100069 [2]首都医科大学燕京医学院,北京101300

出　　处：《中国卫生经济》2025年第2期79-83,共5页Chinese Health Economics

基　　金：2023年首都卫生管理与政策研究基地开放性课题项目(2023JD06);2024年首都卫生管理与政策研究基地开放性课题项目(2024JD02)。

摘　　要：目的:调查分析按疾病诊断相关分组(Diagnosis Related Groups,DRG)支付方式改革中编码员的可能行为。方法:通过调查问卷收集编码员的可能行为,根据因子分析提取行为公因子;采用K-均值聚类法对编码员群体进行聚类。结果:将编码员的可能行为分为遵循编码规范和标准等正向行为和阅读病历不细致而直接编码等负向行为;小于等于25岁的编码员倾向采用负向行为,副高级职称、对DRG认知水平较高倾向于正向行为。将编码员群体分为倾向于采取正向行为的“积极型群体”和负向行为的“消极型群体”。结论:编码员采用正向行为的可能性更大,应关注不同人口学特征对编码员行为的影响;对不同类别的编码员群体采取不同的管理策略,分层分类加强培训,提升编码员对DRG的认知水平,更有利于正向行为的选择。Objective:To analysis the possible behavior of coders in the reform of Diagnosis Related Groups(DRG) payment mode.Methods:To collect through questionnaires the possible coders' behaviors,and extract the common factors of possible behaviors according to factor analysis, and cluster the coders by the K-means clustering method.Results:Classify the possible coders' behaviors into positive behaviors such as following coding norms and standards, and negative behaviors such as directly coding without detailed reading of medical records. Less than 25 years old were more inclined to adopt negative behaviors, and associate senior titles and higher cognitive level of DRG were more inclined to adopt positive behaviors. The coders are divided into "positive group" who tend to take positive behaviors and "negative group" who take negative behaviors.Conclusion:Coders are more likely to adopt positive behavior,and we should be pay attention to the impact of different demographic characteristics on coders. To adopt different management strategies for different categories of coders, and strengthen training through hierarchical classification,and enhance coders' cognitive of DRG are more conducive to the selection of positive behaviors.

关 键 词：疾病诊断相关分组 编码员 行为分析 因子分析 聚类分析 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R-055