基于按病种付费医保支付方式改革的医院 信息化探索

Exploration of Hospital Informatization Based on DRGs Medical Insurance Payment Method Reform

目的:建设按病种付费(DRGs)信息系统,提高病历入组率,促进医院提高资源利用效率,提升医院质量管理水平。方法:基于一体化信息平台,构建院端分组器引擎,对病案进行智能校验,实现精确预测分组,完成诊断、手术等编码的映射,改善临床病历书写质量,完成数据的精细化治理和质控,实现病案数据的准确上传和入组,同时提供DRGs分组智能查询,方便管理部门及时监管。结果:借助信息化手段,切实保证病历的书写、归档、编码、上传、入组等全流程管理,并支持数据智能分析功能。对比系统上线前后,病案首页七日上传率、病例组合指数、时间消耗指数以及费用消耗指数得到显著改善,平均住院天数及低风险病死率显著降低。结论:DRGs医保支付方式改革的信息化探索,有助于本院在医保政策下开展有效引导院内DRGs管理及合理控费途径。同时,为管理部门以及临床医院提供决策支持,助力医院高质量发展。

Objective:The DRGs information system was built to improve the enrollment rate of medical records,promote the hospital to improve the efficiency of resource utilization,and improve the quality management of the hospital.Methods:Based on the integrated information platform,the hospital end grouping engine was built to conduct intelligent verification of medical records,achieve accurate prediction of grouping,complete the mapping of diagnosis,surgery and other codes,improve the writing quality of clinical medical records,complete the fine management and quality control of data,realize the accurate upload and enrollment of medical records data,and provide DRGs group intelligent query to facilitate timely supervision by the management department.Results:With the help of information technology,the whole process management such as writing,archiving,coding,uploading and grouping of medical records is guaranteed,and the data intelligent analysis function is supported.Compared with before and after the launch of the system,the seven-day upload rate of the first page of medical records,case mix index,time consumption index and cost consumption index were significantly improved,and the average length of hospitalization and low-risk mortality were significantly reduced.Conclusion:The informatization exploration of DRGs medical insurance payment reform is helpful for our hospital to carry out effective guidance of DRGs management in the hospital under the medical insurance policy and reasonable cost control methods,and at the same time,provide decision-making support for management departments and clinical departments,and help the hospital develop in high quality.