基于CHS-DRG分组的某三甲综合医院QY病案分析

Analysis of QY Medical Records in a Tertiary General Hospital Based on CHS-DRG Grouping

目的分析某三甲综合医院CHS-DRG分组中歧义(QY)病案的数据质量问题,提出解决方案,以期提高病案首页质量及DRG入组率。方法调取某院经医保局CHS-DRG分组后的2022年7月1日-12月31日出院结算的124份QY病案,以问题为导向分析存在问题的原因并运用Excel工具对问题及原因进行归类、统计和分析。结果124份QY病案中肿瘤科最多为20例,占比16.13%;责任方面编码员最多,占比35.48%,其次是医保部门分组方案占比为34.68%;临床医师主诊断选择错误21例,占比诊断与手术选择错误的56.76%;编码员主要诊断编码错误24例,占编码错误情况54.54%,主要手术编码错误17例,38.64%;主要诊断与主要手术编码均错误为3例,占比6.82%。结论出现QY病案原因既有编码员也有临床医师及DRG分组方案问题,医院应加强临床医师的病案及DRG相关管理与培训,针对编码员探索专科编码员模式,利用信息化手段进行病案首页质控,与相关部门沟通完善分组方案,进而提高DRG入组准确率。

Objective To analyze the data quality of ambiguous(QY)medical records in CHS-DRG grouping in a tertiary general hospital,and propose solutions to improve the quality of the first page of medical records and the enrollment rate of DRGs.Methods A total of 124 QY medical records discharged from a hospital from July 1 to December 31,2022 after being grouped by CHS-DRG of the medical insurance bureau were collected.The causes of the problems were analyzed by problem-oriented analysis,and Excel tools were used to classify,count and analyze the problems and causes.Results Among the 124 QY medical records,there were 20 cases of oncology,accounting for 16.13%;in terms of responsibility,coders accounted for the largest proportion,accounting for 35.48%,followed by the medical insurance department grouping scheme,accounting for 34.68%;there were 21 cases of clinicians'wrong choice of main diagnosis,accounting for 56.76%of the wrong choice of diagnosis and operation.The coder mainly diagnosed 24 cases of coding errors,accounting for 54.54%of coding errors,and 17 cases of main surgical coding errors,accounting for 38.64%;the main diagnosis and main surgical coding errors were 3 cases,accounting for 6.82%.Conclusion The causes of QY medical records include both coders and clinicians and DRG grouping schemes.Hospitals should strengthen the management and training of clinicians'medical records and DRGs,explore the mode of specialist coders for coders,use information means to control the quality of the first page of medical records,communicate with relevant departments to improve the grouping scheme,and then improve the accuracy of DRG grouping.