DIP支付下地市级医院低倍率病例管理实践

Practice of Low Rate Cases Management in Municipal Hospitals under DIP Payment

目的:总结按病种分值付费(DIP)下三级综合医院低倍率病例的特征,探索低倍率病例管理方法。方法:统计2022年1-10月样本医院DIP结算的低倍率病例中Z51.病例及其科室分布,采用χ^(2)检验和t检验,比较分析Z51.低倍率病例组和正常费率组在DIP拨付比、住院天数、治疗方式等方面的差异。结果:样本医院低倍率病例占18.44%,其中Z51.病例占57.56%,手术科室Z51.低倍率病例明显高于非手术科室,Z51.正常费率组例均费用及DIP拨付比明显高于低倍率组,单日住院天数有显著性差异(P<0.05)。结论:DIP支付下,医院可通过提高病案首页编码质量、规范临床路径、加强医疗行为监管、开展成本核算、开设肿瘤日间病房等措施,加强低倍率病例管理。

Objective To summarize the characteristics of low rate cases in a municipal tertiary general hospital under DIP payment,and to explore methods for low rate cases management.Methods From January to October 2022,the distribution of Z51 cases and their departments among low rate cases in the sample hospital under DIP payment were counted.Chi-squared test and t-test were used to compare and analyze the differences between Z51 low rate case group and normal rate case group in terms of DIP disbursement ratio,hospital stay and treatment methods.Results The low rate cases in the sample hospital accounted for 18.44%,of which Z51 cases accounted for 57.56%.Z51 low rate cases in surgical departments were significantly higher than those in non-surgical departments.The average cost and DIP disbursement ratio of Z51 normal rate cases group were significantly higher than those of Z51 low rate cases group,and the length of hospital stay were significantly different(P<0.05).Conclusion In order to strengthen the management of low rate cases under DIP payment,the hospital should improve the coding quality of the first page of medical records,standardize the clinical pathway,strengthen the supervision of medical behavior,implement cost accounting and open a tumor day care ward.