探讨某二级医院低风险死亡病例的影响因素

Discussion on the Influencing Factors of Low-risk Death Cases in a Secondary Hospital

目的通过分析基于DRGs的入组低风险死亡病例的原因,查找解决方法,减少低风险死亡病例发生率。方法根据北京地区住院医疗服务绩效评价平台反馈某二级综合医院2016年1月1日-2021年12月31日住院患者DRGs数据,获得19例低风险死亡病例,临床专家与编码专家联合对每份进行督查审核、分析原因。结果按疾病系统构成情况,骨髓增生疾病和功能障碍,低分化肿瘤占比最高,占42.11%。按入组低风险死亡组原因情况,临床诊疗过程存在问题占低风险死亡病例的57.89%;住院病案首页数据填写错误占低风险死亡病例的36.84%;住院病案分组器数据相关问题占低风险死亡病例的5.26%。结论临床科室诊疗欠规范和住院病案首页主要诊断的选择错误是出现低风险死亡病例的主要因素。通过对低风险死亡病例的分析,找出临床诊疗或管理过程存在的问题加以改进,从而减少低风险死亡病例入组率,有利于持续改进医疗质量。

Objectives This study aims to find solutions to reduce the incidence of low-risk death cases by analyzing the causes of low-risk death cases enrolled based on DRGs.Methods According to the DRGs data of inpatients in a secondary general hospital from January 1,2016 to December 31,2021 fed back by the inpatient medical service performance evaluation platform in Beijing,19 low-risk death cases were obtained.Clinical experts and coding experts jointly supervised and reviewed each copy and analyzed the reasons.Results According to the composition of the disease system,myeloproliferative diseases,bone marrow dysfunction,and poorly differentiated tumors accounted for the highest proportion,accounting for 42.11%.According to the causes of the low-risk death group,problems in the clinical diagnosis and treatment process accounted for 57.89%of the low-risk death cases.Incorrect data filling on the front page of inpatient medical records accounted for 36.84%of low-risk death cases.Issues related to inpatient case grouper data accounted for 5.26%of low-risk deaths.Conclusions Substandard diagnosis and treatment in clinical departments and wrong selection of the main diagnosis on the front page of inpatient medical records are the main factors for the occurrence of low-risk death cases.Finding out the problems existing in the clinical diagnosis and treatment or management process and improving them through the analysis of low-risk death cases can reduce the enrollment rate of low-risk death cases,which is conducive to continuous improvement of medical quality.