基于诊疗推荐知识库的医院端DRG智慧管理系统

Hospital-end DRG intelligent management system based on diagnosis and treatment recommendationknowledge base

目的:构建科学、和谐、共赢的疾病诊断相关分组(DRG)支付生态体系。方法:以患者为中心建立质量管理路径,基于全结构化电子病历构建院内DRG诊疗推荐知识库,并设计运营分析体系,实时分层分析医保局端反馈数据,构建医院端DRG智慧管理系统。结果:系统实施1年后,我院CMI提升了14.9%,DRG组数由652组提升到了664组,时间消耗指数下降了6.4%,费用消耗指数下降了1.9%,次均费用下降了4.1%,结付率上升了8.8%。结论:基于诊疗推荐知识库的医院端DRG智慧管理系统有效提升了医院的医疗能力、医疗效率以及医疗效益。

Objective To build a scientific,harmonious and win-win payment ecosystem for Diagnosis Related Groups(DRG).Methods A patient-centered quality management path was established,and a DRG diagnosis and treatment recommendation knowledge base was constructed based on the fully structured electronic medical records.An operational analysis system was designed to analyze the feedback datas from the medical insurance bureau in real time and hierarchically,so as to realize the hospital-end DRG intelligent management system.Results After the implementation of the system,the CMI of our hospital increased by 14.9%,the number of DRG groups increased from 652 to 664,the time consumption index decreased by 6.4%,the cost consumption index decreased by 1.9%,the average cost per visit decreased by 4.1%,and the settlement rate increased by 8.8%.Conclusion The DRG intellgent management system effectively improves the hospital's capability,efficiency and benefits in providing medical service.