197例DRG分组QY病例产生原因分析

Analysis of the Causes of 197 QY Cases in DRG Group

目的分析DRG分组中QY病例产生原因,减少不合理填报,以提高DRG的有效入组率。方法调取某三甲综合医院2021年10月1日-2022年9月30日北京地区医疗绩效服务平台上的DRG系统反馈的QY病例197例,通过描述性统计分析对原主要诊断和手术操作进行分析。结果QY病例占整个病例DRG组的0.26%,神经系统疾病及功能障碍组产生QY病例最多,占43.15%;头颈、耳、鼻、口、咽疾病及功能障碍组和肌肉、骨骼疾病及功能障碍组,均占比9.64%。因填报问题造成的QY病例有40例,占比20.30%。结论临床医师应熟悉病案首页填报原则,正确填报主要诊断和主要手术操作,编码员准确编码,DRG管理部门应根据反馈结果对分组细节不断地调整。

Objectives This study aims to analyze the causes of QY cases in DRG grouping,reduce unreasonable reporting,and improve the effective enrollment rate of DRG.Methods 197 QY cases reported by the DRG system on the medical performance service platform in Beijing from October 1,2021 to September 30,2022 in a tertiary general hospital were retrieved.The original primary diagnosis and surgical procedures were analyzed by descriptive statistical analysis.Results QY cases accounted for 0.26%of the entire DRG group,and nevrological disease and dysfunction group produced the most QY cases,accounting for 43.15%.Head,neck,ear,nose,mouth,pharynx disease and dysfunction group and muscle and bone disease and dysfunction group all accounted for 9.64%.There were 40 QY cases caused by reporting problems,accounting for 20.30%.Conclusions Clinicians should be familiar with the principles of filling in the first page,and correctly fill in the main diagnosis and main operation.Coders should code accurately.At the same time,the DRG management department should continuously adjust the grouping details according to the feedback results.