运用MDT降低DRG医保支付方式下歧义病案的探讨

A discussion of the use of mdt to reduce the ambiguity of medical records under the medical insurance payment mode of DRG

目的探讨MDT管理模式在DRG医保支付方式下歧义病案中的应用及效果。方法将医保数据平台反馈的广西某医院2020年12月—2021年3月出院的医保病案共计6509份作为研究对象,其中2020年12月1日—2021年1月31日出院的医保病案3238份归入此次研究的对照组,2021年2月1日—3月31日出院的医保病案3271份归为此次研究的干预组。对照组的病案未实施MDT模式管理,干预组的病案均接受MDT管理,比较两组数据的主要诊断、主要手术操作错误率情况以及歧义病案的发生率。结果干预组歧义病案较之对照组明显下降,且干预组的主要诊断、主要手术操作错误率均低于对照组,差异具有统计学意义(P<0.05)。结论MDT通过组建MDT小组、加强培训与反馈、病案首页前置质控、优化科室管理等一系列手段,全面构建联动工作机制,使多部门联合参与、共同监管,提高住院病案首页数据质量,降低主要诊断、主要手术操作填写错误率,降低歧义病案的发生。

Objective To explore the application and effect of MDT management mode in the ambiguous medical records under the DRG medical insurance payment mode.Methods A total of 6509 medical insurance medical records from a hospital in Guangxi from December 2020 to March 2021,which were reported by the medical insurance data platform,were taken as the research object,among which 3238 medical insurance medical records from December 1,2020 to January 31,2021 were included in the control group of this study.A total of 3,271 medical records from February 1 to March 31,2021 were included in the intervention group of this study.The medical records of the control group were not managed by MDT mode,while those of the intervention group were all managed by MDT.The main diagnosis,the error rate of major surgical procedures and the incidence of ambiguous medical records were compared between the two groups.Results The number of ambiguous cases in the intervention group was significantly lower than that in the control group,and the error rate of main diagnosis and main operation in the intervention group was lower than that in the control group.The difference was statistically significant(P<0.05).Conclusion By forming MDT group,strengthening the training and feedback,optimizing the management department and a series of means,MDT set up a mechanism of working comprehensively with multi-sectoral joint participation and mutual supervision to improve the quality of hospital medical record home page data,reduce the main diagnosis and main operation to fill in error rate,and reduce the ambiguity of the medical record.