基于关系数据库构建DIP结合DRG体系在医院儿科学科建设中的应 用

Application of DRG and DIP based on relational database in hospital pediatric discipline construction

目的研究基于关系数据库的按病种分值付费(DIP)和疾病诊断相关分组(DRG)相结合体系的构建,并应用于公立综合医院的儿科学科建设中,探讨学科建设的发展方向。方法应用政府平台提供的DRG和DIP评价体系,关联医院病案首页数据库,计算2018—2020年儿科住院患者对应的DRG和DIP评价指标,探讨实现医保控费和学科发展双赢的措施。结果2018—2020年医院收治疑难重症病人能力、效率和安全变化不大,病例组合指数(CMI)分别维持在0.45~0.47(普通儿科)和1.43~1.54(新生儿科),时间和费用效率指数在0.74~0.87,没有中低风险组死亡,除了新生儿科的疑难患者比例在2020年从原来的24.68%降至17.71%。总体医保控费情况尚可,到2020年实现了普通儿科和新生儿科无亏损。收治的部分高CMI的病种具有发展潜力,如普通儿科的“病毒性脑、脊髓和脑膜炎,不伴合并症与伴随病”和新生儿科的“新生儿伴呼吸窘迫综合征”和“早产儿伴严重问题”等。结论DRG和DIP相结合的评价体系构建,可不依赖第三方公司,实现学科建设发展态势、医保控费着力点、学科未来发展定位的把握。

Objective To study the construction of digital image processing(DIP)and diagnosis related grouping(DRG)combined system based on relational database,and apply it to pediatric discipline construction in public general hospitals,and explore the development direction of discipline construction.Methods By applying the evaluation system of DRG and DIP provided by the government platform and associated with the hospital medical record homepage database,the corresponding evaluation indexes of DRG and DIP for pediatric inpatients from 2018 to 2020 were calculated,and the win-win measures for medical insurance expense control and discipline development were discussed.Results From 2018 to 2020,the ability,efficiency and safety of hospital treatment of difficult and severe patients had not changed much.The case mix index(CMI)was maintained at 0.45-0.47(general pediatrics)and 1.43-1.54(neonatology),respectively,and the time and cost efficiency index was 0.74-0.87.There were no deaths in the medium-low risk group,except that the proportion of difficult patients in neonatology decreased from 24.68%to 17.71%in 2020.The medical insurance cost was co ntrolled well and by 2020,there was no loss in the general and neonatology departments.Some of the high CMI diseases admitted had development potential,such as"viral brain,spinal cord and meningitis without comorbidities"in the general department of pediatrics and"neonatal respiratory distress syndrome"and"premature infant with serious problems"in the department of neonatology.Conclusion The combination of DRG and DIP is the approach of understanding the development trend of the discipline construction and well-controlling medical insurance cost,as well as grasping the future development orientation of the discipline,without depending on other software companies.