基于DRGs绩效平台未入组病例原因分析

Analysis on the Causes of Unenrolled Cases of DRGs Performance Evaluation System

目的分析某儿童医院住院病例在DRGs绩效评价平台中未入组原因,提高DRGs入组率。方法医院2017年1月1日-2019年12月31日间住院病案首页数据经绩效评价平台进行DRGs分组处理,对未入组的每份病例根据平台错误提示与编码规则、诊断书写、病案首页填写等要求进行深入分析,明确未入组原因。结果共上传住院病案首页数据44 103份,未入组病例151份,未入组率0.34%。未入组具体原因为院内使用的编码字典库混乱致非标准编码错误(73例)、不符合新生儿定义或信息缺失致新生儿诊断不符(42例)、使用与患者性别不一致的疾病诊断和(或)手术操作致性别不符(28例)、主要诊断选择不当及绩效平台分组规则不完善致无效主要诊断(8例)。结论以未入组病例具体原因为导向,对以往错误原因进行梳理、建立问题库,分科室分专业强化临床医师培训,提升病案编码水平,完善信息系统功能,建立住院病案首页质量及考核结果与晋职晋升、绩效考核、年终奖励等管理奖惩机制,能够切实加强住院病案首页质量而有效提高DRGs入组率。

Objectives To analyze the causes of unenrolled cases in a children’s hospital by DRGs performance evaluation system, and improve the enrollment rate of DRGs. Methods The data of front page of discharged patients from 2017 to 2019 was derived, and grouped by DRGs performance evaluation system, selected and analyzed unenroll case by the error of DRGs performance evaluation system and coding rules, diagnostic writing, front page filling, to find out the existing problem. Results The number of discharged patients was 44103, and unenrolled cases was 151(0.34%). The specific reasons for that were the confusion of the coding dictionary used in the hospital which induced the non-standard coding errors(73 cases), the admission weight of neonatal is missing or older than 28 days infants using neonatal diagnosis caused mismatches in neonatal diagnosis(42 cases), the disease diagnosis and/or surgical operation inconsistent with the child’s gender resulted in gender inconsistency(28 cases), unsuitable selection of main diagnosis and improper grouping of DRGs evaluation system produced invalid main diagnosis(8 cases). Conclusions To take the specific reasons of unenrolled cases as the guidance, carding to usual fault reasons, establish library, department professional strengthening clinical training, enhance the level of medical record coding and perfect the function of information system, to establish hospital quality of medical record front pages and the assessment results and determination of promotion, performance appraisal, year-end bonus, such as management link rewards and punishment mechanism, thus to strengthen the quality of hospital medical record front page and effectively improve the DRGs into the group rate.