某市三级医院住院病案首页质量改进对DRGs绩效评价的影响

目的研究北京市某医院住院病案首页质量,探讨住院病案首页质量改进对DRGs绩效评价的影响。方法收集北京市某区域医疗中心综合三级医院2017年2月1日-2018年1月31日的住院病案首页数据,应用BJ-DRGs分组软件和Epidata软件收集原始数据,通过对医师书写及编码专业培训,将2017年2月1日-7月31日出院病案做为对照组,2017年8月1日-2018年1月31日出院病案做为研究组,分析2组数据对DRGs绩效评价的影响变化,从医疗服务产出、医疗服务效率、医疗服务质量3个维度进行住院医疗绩效评价。结果通过住院病案首页规范管理培训,住院病案首页在入院诊断、主要诊断、手术操作、其他诊断等几个方面填写的错误率明显下降。其中入院诊断错误率从24.00%下降到9.33%;主要诊断错误率从28.00%下降到10.67%;手术操作错误率从5.67%下降到0;其他诊断错误率从89.33%下降到18.67%;改进前后住院病案首页数据比较,DRGs组数从391增加到423;总权重数从5893.12增加到6238.32;CMI值从0.89提升到0.93;低风险组死亡率由0.20%降低为0;时间效率指数从0.89降低到0.82;费用效率指数从0.98下降到0.96,综合分值从1.32上升到1.36。住院病案首页错误率与综合分值呈负相关,相关系数r=-0.991,回归系数b=-1.602,P<0.05。结论住院病案首页质量的提高在一定程度上影响了DRGs的绩效评价,为了客观的评价DRGs绩效,通过对病案首页主要诊断、手术操作等的质控,提升了住院病案首页的质量,使病案首页数据更能客观地评价DRGs绩效。

Effect of Front Pages Quality of Inpatient Medical Records on DRGs Performance Evaluation in a Three Grade Hospital in Beijing

Objectives To study the quality of the front pages of inpatient medical records in a hospital in Beijing,and discussed the influence of the improvement on the front pages of inpatient medical records on DRGs performance evaluation.Methods To collect a regional medical center in Beijing comprehensive tertiary hospitals in February 2017 to January 2018 in the hospital medical record home page data,application software and BJ-DRGs grouping Epidata software to collect the raw data,written by physicians and coding professional training,in February 2017 to July out of the hospital medical record as the control group,in August 2017 to January 2018 discharged medical record as a team,the analysis of the effect of two groups data for performance evaluation of DRGs changes,from medical service output and efficiency of medical service,medical service performance evaluation of three dimensions for hospital medical quality.Results Through the standardized management training of the front pages of the inpatient medical record,the error rate of the front pages of the inpatient medical record in admission diagnosis,main diagnosis,surgical operation,other diagnosis and other aspects of filling in the error rate decreased significantly.Among them,the diagnosis error rate of admission decreased from 24.00% to 9.33%.The main diagnostic error rate decreased from 28.00% to 10.67%.Surgical error rate decreased from 5.67% to 0.Other diagnostic errors dropped from 89.33% to 18.67%.The DRGs group increased from 391 to 423.The total weight increased from 5893.12 to 6238.32.The CMI value rose from 0.89 to 0.93.The mortality rate of the low-risk group decreased from 0.20%to 0.The time efficiency index decreased from 0.89 to 0.82.The cost-efficiency index fell from 0.98 to 0.96 and the composite score rose from 1.32 to 1.36.The error rate of the first page of hospital records was negatively correlated with the composite score,with the correlation coefficient r=-0.991,and the regression coefficient b=-1.602,P<0.05.Conclusions To some extent,the improvement of the quality of the front pages of hospital records affects the performance evaluation of DRGs.In order to objectively evaluate the performance of DRGs,the quality of the front pages of hospital records was improved through the quality control of the main diagnosis and surgical operation of the front pages of medical records,so that the front pages of medical records could more objectively evaluate the performance of DRGs.