DRG应用中疼痛科歧义病案的探讨

Discussion on Ambiguity Medical Records of Pain Department in DRG Application

目的 分析广西某三级综合医院疼痛科按DRG付费的出院病案,总结歧义病案发生的原因,提出改进建议。方法 选择该医院疼痛科2020年12月1日-2021年6月30日期间,上传至DRG结算系统并经分组器分组后的201份病案,其中歧义病案21份,通过人工复核的方式进行回顾性分析。结果 该科室入组病案180份,入组率为89.55%,具有手术/操作病案156份,歧义病案21份,歧义病案发生率为13.46%。歧义病案发生的原因可归纳为:主要诊断选择错误1份、主要手术选择错误1份、编码错误1份、分组规则因素18份。结论 临床医师和医院管理人员均应深入DRG相关知识的学习和研究,加强对编码员专业知识的培训,通过分析歧义病案发现的问题,规范自身填报的同时,及时反馈上级部门,助力医保支付方式改革。

Objectives This paper analyzed the discharge cases paid by DRG in the pain department of a tertiary general hospital in Guangxi,summarized the causes of ambiguous cases,and put forward suggestions for improvement.Methods From December 1 st,2020 to June 30 th,2021 in the pain department of the hospital,201 medical records uploaded to the DRG settlement system and grouped by the grouper were selected for retrospective analysis through manual review.Results The department enrolled 180 medical records,and the enrollment rate was 89.55%.There were 156 surgical/operation medical records and 21 ambiguous medical records.The incidence of ambiguous medical records was 13.46%.The reasons for the occurrence of ambiguous medical records could be summarized as:1 case of main diagnosis selection error,1 case of main surgery selection error,1 case of coding error,and 18 cases of grouping rule factors.Conclusions Clinicians and hospital managers should study and research DRG-related knowledge in depth,strengthen the training of professional knowledge of coders,and standardize their filling by analyzing the problems found in ambiguous medical records,and at the same time,timely feedback to the superior department to help the reform of medical insurance payment methods.