[1]徐少博,张新静,丁晓飞,等.DIP支付方式改革对病案首页主要诊断及主要手术编码质量的影响[J].医学信息,2023,36(11):67-70.[doi:10.3969/j.issn.1006-1959.2023.11.011]
　XU Shao-bo,ZHANG Xin-jing,DING Xiao-fei,et al.Influence of the DIP Payment Reform on the quality of Main Diagnosis and Main Surgical Coding on the Medical Record Home Page[J].Journal of Medical Information,2023,36(11):67-70.[doi:10.3969/j.issn.1006-1959.2023.11.011]
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DIP支付方式改革对病案首页主要诊断及主要手术编码质量的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年11期
页码:
67-70
栏目:
卫生管理信息学
出版日期:
2023-06-01

文章信息/Info

Title:
Influence of the DIP Payment Reform on the quality of Main Diagnosis and Main Surgical Coding on the Medical Record Home Page
文章编号:
1006-1959（2023）11-0067-04
作者:
徐少博; 张新静; 丁晓飞; 等
（1.宿迁市第一人民医院质量管理处，江苏 宿迁 223800；2.河海大学公共管理学院，江苏 南京 210098）
Author(s):
XU Shao-bo; ZHANG Xin-jing; DING Xiao-fei; et al.
(1.Quality Management Office of Suqian First People’s Hospital,Suqian 223800,Jiangsu,China;2.School of Public Administration,Hohai University,Nanjing 210098,Jiangsu,China)
关键词:
DIP; 主要诊断及主要手术; ICD
Keywords:
DIP; Main diagnosis and main surgery; ICD
分类号:
R197.3；R19-0
DOI:
10.3969/j.issn.1006-1959.2023.11.011
文献标志码:
A
摘要:
目的 以病案首页主要诊断及主要手术编码质控结果为数据来源，分析DIP支付方式改革前后某院病案首页主要诊断及主要手术编码质量变化情况及影响因素，为提高病案首页主要诊断及主要手术编码质量提供依据。方法 检查DIP支付方式改革前（2020年1月-12月）和DIP支付方式改革后（2021年1月-12月）某院出院患者病案首页主要诊断及主要手术编码选择情况，对病案首页中出现主要诊断及主要手术编码错误的项目进行统计，比较DIP前后病案首页主要诊断及主要手术编码发生错误的区别。结果 DIP支付方式改革前出院病案首页共41 545份，主要诊断编码正确率83.40%，其中有手术操作的首页共20 739份，主要手术编码正确率85.60%。DIP支付方式改革后出院病案首页共47 771份，主要诊断编码正确率93.30%，其中有手术操作的首页共27 486份，主要手术编码正确率94.14%。结论 DIP对病案首页主要诊断及主要手术编码质量有正向促进作用，但是依然存在主要诊断及主要手术编码正确率不高、主要诊断及主要手术选择错误、该合并编码未合并、肿瘤部位编码与病理结果不符合及编码与诊断不匹配等问题。
Abstract:
Objective To analyze the changes and influencing factors of the main diagnosis and main surgical coding quality of the medical record home page before and after DIP payment reform, and to provide a basis for improving the quality of the main diagnosis and main surgical coding of the medical record home page.Methods Before the DIP payment reform (January-December 2020) and after the DIP payment reform (January-December 2021), the main diagnosis and main surgical coding selection of the medical record home page of discharged patients in a hospital were examined. The items of main diagnosis and main surgical coding errors in the medical record home page were counted, and the differences of main diagnosis and main surgical coding errors in the medical record home page before and after DIP were compared.Results Before the DIP payment reform, there were 41 545 medical record home pages of discharged medical records, with the main diagnostic coding accuracy of 83.40%. Among them, there were 20 739 medical record home pages with surgical operation, with the main surgical coding accuracy of 85.60%. After the DIP payment reform, there were 47 771 medical record home page of discharged medical records, and the main diagnostic coding accuracy was 93.30%. Among them, there were 27 486 medical record home page with surgical operations, and the main surgical coding accuracy was 94.14%.Conclusion DIP has a positive effect on the quality of the main diagnosis and main surgery coding on the medical record home page, but there are still some problems, such as low accuracy of the main diagnosis and main surgery coding, wrong selection of the main diagnosis and main surgery, unmerged codes, tumor site coding and pathology inconsistent results and mismatches between coding and diagnosis.

参考文献/References:

[1]中共中央,国务院.关于深化医疗保障制度改革的意见[EB/OL].(2020-03-25)[2022-06-18].http://www.gov.cn/zhengce/2020-03/05/content_5487407.htm.[2]国家医疗保障局办公室.国家医疗保障局办公室关于印发区域点数法总额预算和按病种分值付费试点城市名单的通知[EB/OL].(2020-11-04)[2022-06-18].http://www.nhsa.gov.cn/art/2020/11/4/art_37_3812.html.[3]国家医疗保障局办公室.国家医疗保障局办公室关于印发国家医疗保障按病种分值付费(DIP)技术规范和DIP病种目录库(1.0版)的通知[EB/OL].(2020-11-20)[2022-06-18].http://www.nhsa.gov.cn/art/2020/11/20/art_37_3987.html.[4]国家卫生计生委办公厅.国家卫生计生委办公厅关于印发住院病案首页数据填写质量规范(暂行)和住院病案首页数据质量管理与控制指标(2016版)的通知[EB/OL].(2016-06-27)[2022-06-18].http://www.nhc.gov.cn/yzygj/s2909/201606/fa8a993ec972456097a2a47379276f03.shtml.[5]徐一引.病案首页ICD编码质量控制及改进措施[J].中国医院统计,2017,24(6):475-477.[6]杨玉营.病案首页ICD编码质量控制及改进措施[J].中国卫生标准管理,2020(19):7-10.[7]谭清立,刘思妍,柳丹玲,等.按病种分值付费对医生行为的影响——基于实验经济学[J].中国卫生政策研究,2021,14(9):14-19.[8]马茹君,纪艳,孙国梅.疾病编码质量的分析研究与对策[J].安徽卫生职业技术学院学报,2017,16(6):6-7[9]刘嫁如,黄铎,白玲.住院病案首页上报信息的督导检查设计与评分[J].中华医院管理,2015,31(11):834-836.[10]杨惠萍.病案信息化管理再医院发展中的作用探讨[J].中国卫生标准管理,2020,11(2):1-3.[11]李增芳,丁松瑞,赵敏,等.公立医院绩效考核背景下某医院病历档案首页常见问题分析[J].医学信息,2020,33(22):145-146.[12]苏倩,胡娟.PDCA循环管理在ICD编码质量管理中的应用[J].中国病案,2021,22(9):15-17.[13]贾友波,宋宪锟.PDCA循环在病案首页质量持续改进中的应用[J].中国病案,2020,21(9):16-18.[14]肖婷.基于DIP付费模式下对ICD编码质量的思考[J].医学信息,2022,35(1):35-38.[15]张晓娜,杨卫林.基于大数据技术的病案智能编码系统的功能设计与应用探究[J].科学技术创新,2021(3):82-83.[16]许速,谢桦,崔欣,等.基于大数据的病种分值付费的原理与方法[J].中国医疗保险,2020(9):23-28.[17]贾洪波,段文琦.基本医保按病种分值付费的实践探讨[J].卫生经济研究,2018,373(5):57-59．[18]黄逸辉.按病种分值付费医保支付方式下动脉硬化性心脏病患者住院费用分析[J].现代医院,2021,21(11):1728-1731.

更新日期/Last Update: 1900-01-01