军队医院DRG付费试点实践与体会

The Practice and Achievement of a Pilot in Military Hospitals for DRG Payment System

目的构建与医保DRG付费相适应的信息流程和组织流程,实现与医保DRG付费系统的全面对接。方法建立标准的编码数据库和病案首页填报系统并及时更新,加强医务人员培训,改进军队医院病案首页填报质量和填报效率,实施临床路径管理,新增病案交互功能设置,引入DRG智能软件,制订相关数质量分析评价考核机制。结果解放军总医院第四医学中心被遴选为执行DRG实际付费的首家驻京军队医疗机构,历经三年多模拟运行实践,病历组合指数(case mix index,CMI)从试运行初期的0.96跃升为1.22,病种入组率从95%升至99%。结论信息和组织两个流程的构建和优化是推行DRG付费的前提和基础,二者相互补充,缺一不可,此举为军队医院DRG付费从试点到实际应用积累了经验。

Objective This system aims to construct an informational process and organizational process suitable for DRG payment of local medical insurance and realize the comprehensive connection with the DRG payment system of local medical insurance.Methods We established a standardized coding database and a medical record homepage reporting system with timely update,trained the medical staff intensively,improved the quality and efficiency of the homepage report of military hospitals,implemented the management of clinical pathway,built up new medical record in-teraction function settings,introduced DRG intelligent software,and established a relevant quantitative analysis,evalua-tion and assessment mechanism.Results After the operational practice of simulation more than three years,the CMI(medical record combination index)boosted from 0.96 to 1.22 during the process of the trial operation,and the enroll-ment rate of the disease boosted from 95%to 99%.This process made our hospital the first military medical institution that implements DRG payment in Beijing.Conclusion The construction of the dual process of information and organi-zation,which is complementary and indispensable,forms the premise and basis for the implementation of DRG pay-ment,and accumulates experience for the military hospital DRG payment from pilot to practical application.