运用PDCA循环缩短医保病历审核时间

Application of PDCA circulation on shortening medical records review time of the medical insurance patients

目的:探讨缩短医保病历审核时间的有效方式,为提高审核效率、不断改善服务质量提供参考依据。方法:运用PDCA循环原理,对影响医保病历审核的因素进行分析,找出其中的主要原因,制定针对性措施实施过程改进。结果:实施改进措施后,通过进一步修订制度、改进流程、引入电子化系统及加强管理等方面,人均日审核病历份数由原先3.55份提升至4.72份,提升率达33.1%。结论:PDCA循环的应用缩短了医保病历审核时间,实现医院医保审核质量及效率的持续提高。

Objectives: To explore the ef ective ways in shortening the review time of medical records in medical insurance patients and to provide reference for continuous improving efficiency and the quality of service. Methods: PDCA circulation was applied to analyze the factors that af ecting the review time, identify the main causes and develop the improvement measures. Results: After implementing the PDCA circle, the institution, business process, information system and management methods have been improved. The numbers of review elevated from 3.55 to 4.72 per day, increased 33.1%. Conclusions: PDCA circulation significantly shorted the review time of medical records in the medical insurance patients, and continuously improving the efficiency and quality of medical insurance management.