DRG联合住院病案首页数据...控在骨科高质量发展中的应用_邓娇.pdf

中国病案2023 年第 24 卷第 7 期 39办发202118 号)_信息公开_中国政府网EB/OL.(2021-05-14)2021-06-04.http:/ 贾媛,王晨,郑陆林,等.国内临床医师绩效评价的关键问题确认分析J.中国医疗管理科学,2022,12(1):35-40.3 胡靖琛,李煜,刘明孝,等.基于 DRG 的主诊组医疗服务能力综合评价J.中国卫生质量管理,2022,29(4):25-29.4 傅欣.医院如何有效实施分层激励J.人力资源,2021,(18)：46-47.5 刘栗池.分层激励在医院人力管理中的应用探讨J.低碳世界,2019,9(8)：353-354.6 李文强,危华冰,莫夏丽,等.住院病案首页主要诊断及主要手术填写的质量改进J.中国病案,2020,21(9):8-10.7 张天,郭瑞.DRG 支付方式改革下的医院运行管理J.理论研究,2020,20(7):98-99.8 许轲,杨剑,邱亭林.加权 TOPSIS 法在临床 DRGs 指标综合评价中的应用J.中国病案,2022,23(1):43-46.9 侯明,肖万超,刘静.DRG 评价指标在医院绩效管理体系中的应用J.江苏卫生事业管理,2021,32(12):1562-1566.(2022-06-30 收稿)DRG 联合住院病案首页数据质控在骨科高质量发展中的应用 邓 娇 喻 敏*桂记龙 摘要 目的 探讨 DRG 联合住院病案首页质控在骨科精细化管理中的应用，以提高数据质量和指标评价的真实性，真实反映专科高质量发展情况。方法 选择骨科 2020 年 1 月 1 日-2020 年 12 月 31 日住院病案首页 2854 例为对照组，2021 年 1 月 1 日-2021 年 12 月 31 日住院病案首页 2 674 例为观察组。对照组采取 DRG 联合院内临床科室质控小组质控和病案室编码员的传统质控方法；观察组在对照组的基础上，增加运营管理科质控，质控结果反馈至院领导、病案科，上下联动通力督查骨科科室主任及临床医师提高数据质量。两组采用 DRG 工具分别对骨科 2020 年和 2021 年所产生的医疗服务能力、效率、费用、安全进行评价，探讨住院病案首页质量对 DRG 指标的影响，及 DRG 联合住院病案首页质控的应用效果。结果 2020年-2021 年骨科缺陷评价指标均下降明显(P0.05)，组间差异有统计学意义。主要诊断选择及编码错误率由 1.89%下降至 1.2%、主要手术操作选择及编码错误率由 0.42%下降至 0.11%、其他诊断错误漏填率由0.81%下降至 0.34%；平均住院诊断条数由 5 条上升至 8 条。DRG 指标方面，观察组的指标均优于对照组，DRG 组数由 107 增加到 113、CMI 值由 1.43 上升至 1.6、高权重占比由 27.22%提升至 31.5%、费用消耗指数有 0.82 下降至 0.79，时间指数均由 1.15 下降至 1.04，中低风险死亡率降至 0，全省专科排名从 82名上升至 24 名。结论 增加住院病案首页运营管理科质控，可以提高专科住院病案首页数据填写质量，减少诊断、手术操作漏填率和错误率，住院病案首页数据产生的 DRG 绩效指标更能反应专科医疗能力和运营管理能力，DRG 联合住院病案首页质控能助力提升专科精细化管理能力，为实现高质量发展提供数据支撑。关键词 DRG；住院病案首页质控；住院绩效评价；专科高质量发展 1 Application of DRG Combined with Data Quality Control on the Front Page of Medical Records in the HighApplication of DRG Combined with Data Quality Control on the Front Page of Medical Records in the High-quality quality Development of Orthopedics Development of Orthopedics Deng Jiao,Yu Min,Gui Jilong Abstract Abstract ObjectivesObjectives This study aims to explore the application of third-party quality control on the front page of DRG combined medical records in the fine management of orthopedics,in order to improve the data quality and the authenticity of the index evaluation,and truly reflect the high-quality development of the specialty.MethodsMethods A total of 2854 orthopedic cases from January 1,2020 to December 31,2020 were selected as the control group,and 2674 cases from January 1,2021 to December 31,2021 were selected as the observation group.The control group adopted DRG combined with traditional quality control methods,namely quality control of the clinical department quality control team and case room coder quality control.On the basis of the control group,the observation group added the quality control of the operation management department,and the quality control results were fed back to the hospital leaders and the case department,and the top and bottom worked together to supervise the director of the orthopedic department and clinicians to improve the data quality.These two groups used DRG tools to evaluate the medical service capacity,efficiency,cost,and safety generated by the homepage of orthopedic cases in 2020 and 2021,respectively.The impact of the quality of the inpatient medical record homepages on DRG indicators and the application effect of DRG combined with the quality control of the inpatient medical record homepages were discussed.Results Results From 2020 to 2021,the evaluation indexes of orthopedic defects decreased significantly(P0.05)and the difference between groups was statistically significant.Major diagnostic options and coding error rates decreased from 1.89%to 1.2%.The major operation selection and coding error rate dropped from 0.42%to 基金项目：2021 年四川省卫生信息学会科研课题(项目编号：2021020)自贡市第一人民医院，四川省，自贡市，643000*通信作者 中国病案2023 年第 24 卷第 7 期 400.11%.The omission rate of other diagnostic errors dropped from 0.81%to 0.34%.The average number of diagnoses on the homepage of inpatient medical records increased from 5 to 8.In terms of DRGs indicators,the indicators of the observation group were better than those of the control group.The number of DRG groups increased from 107 to 113.The CMI value increased from 1.43 to 1.6.The proportion of high weight increased from 27.22%to 31.5%.The cost consumption index decreased from 0.82 to 0.79.The time index decreased from 1.15 to 1.04.The medium and low-risk mortality rates decreased to 0.The ranking of specialties in the province increased from 82 to 24.Conclusions Conclusions Increasing the quality control of the operation management department on the homepage of inpatient medical records improves the quality of data filling on the homepage of specialized inpatient medical records and reduces the rate of missed filling and error rates in diagnosis and surgical operations.The DRG performance indicators generated from the homepage data of inpatient medical records can better reflect the ability of specialized medical care and operation management.DRG combined with the quality control of the homepage of medical records can help improve specialized refined management capabilities,so as to provide data support for achieving hi