吉林省医保定点医院6种疾病主要诊断现状分析

The Current Investigation of the Main Diagnosis of Six Kinds of Diseases in Medical Insurance Designated Hospitals in Jilin Province

目的了解目前吉林省内省医保定点医院的病案首页主要诊断选择与主要诊断ICD-10编码上传质量,找出影响质量的问题所在,提出改进建议。方法从6家省医保定点三甲医院2013年-2014年的出院病案中随机抽取1877份病案,得出各医院6个不同病种上传主要诊断ICD-10编码的现况。结果全部病案中74.37%的病案首页主要诊断选择正确;35.70%的病案上传到省医保部门的主要诊断ICD-10编码是正确的;各个病种在6家医院病案首页主要诊断选择及主要诊断ICD-10编码上传情况是有所差异的,且差异十分悬殊。结论为提高病案首页主要诊断选择与主要诊断ICD-10编码上传的质量,医保部门应和医院通力合作,加强医保部门监管力度,发挥编码人员专业优势,加强人员培训及医院之间的交流,统一并及时更新地区范围内ICD-10编码库,并在此基础上逐步完善其他诊断与手术操作名称编码的上传工作。

Objective To understand the choice of main diagnosis in medical record front pages and main ICD-10 diagnostic code upload quality, find out the cause of the problem and put forward the suggestion of further rationalization in the meantime. Methods Make a randomly selection of 1877 medical records of which the patients discharged in 2013-2014 from six provincial medical insurance designated hospitals in Jilin Province, obtained the status of the choice of main diagnosis in medical record front page and main ICD-10 diagnostic code upload quality.Results The precision was 74.37% in all medical records of main diagnosis in medical front page. 35.70% of all main diagnosis in ICD-10 coding uploaded medical records to the provincial health department is correct. The choice of main diagnosis in medical record front page and main ICD-10 diagnostic code upload quality in six provincial was different in various diseases, and it is a wide disparity sometimes. Conclusions To improve the quality of the choice of main diagnosis in medical record front page and main ICD-10 diagnostic code upload, we put forward the following measures. First, we suggest the medical insurance department to strengthen the supervision and cooperate with hospitals. Second, make further training of the coding workers, make full advantages of their own specialty, and enhance hospital communication. The last but not the least, we should promote the exchange of information between the local hospitals, update the ICD-10 code library timely, and gradually improve the coding of other diagnostic and surgical operation at the same time.