哈尔滨市DRGs系统应用测试问题分析

目的查找疾病诊断相关分组(DRGs)系统测试中所发现的问题,提出相应的改进建议,从而确保DRGs的全面推广和实施。方法基于黑龙江省哈尔滨市57家试点医疗机构2016年1月—2019年9月历史病案及结算数据的相关信息进行测试。结果总体上,DRGs分组器的分组效能指标符合标准。参与分组的3316618份病例中,共有66513份病例未能被成功分入某一个DRGs组。导致病例未入组或分组错误的原因主要有病案数据质量存在问题、分组器未进行属地化调整、主要诊断错误、主要手术信息有误等。结论未入组病例的原因需进一步明确并进行针对性改进,已入组病例需对常见错误分组问题进行筛查和改进,以进一步提高DRGs分组器的分组效能,有效避免问题发生。

The Analysis of Application Test Problems of DRGs Grouping System in Harbin

Objective In order to ensure the comprehensive promotion and implementation of DRGs,this paper analyzes the problems existing in the promotion and application of DRGs system testing,and puts forward corresponding improvement suggestions.Methods The test is based on the relevant information of historical medical records and settlement data of 57 pilot medical institutions in Harbin,Heilongjiang Province,from January 2016 to September 2019.Results In general,the grouping efficiency index of DRGs grouping device meets the standard;among the 3316618 cases participating in the grouping,a total of 66513 cases were not successfully divided into a DRGs group.The main reasons for failed grouping were problems in the quality of medical record data,the unlocalized adjustment of the grouping device,the main diagnostic errors,the main operation information errors,etc.Conclusion The grouping efficiency of DRGs need to be further improved,by making clear the reasons of not included medical records and making targeted improvement,and by analyzing and solving common problems among mistakenly admitted medical records,so as to effectively avoid the problems.