基于院级DRG分组诊疗数据知识库的实时分组管理研究

为进一步激发疾病诊断相关分组(DRG)对医疗资源的管理效能和对诊疗行为的规范作用，提出了一种实时分组方案。根据医院已出院患者的临床诊断、治疗方案等诊疗数据，以大数据统计方式，构建DRG分组诊疗数据知识库，并提出患者诊疗分组、科室出院分组、病案编码分组和医保审核分组四级实时分组方法。实践后成效明显。DRG分组诊疗数据知识库契合医院实际，实时分组方案贯穿患者主要诊断的产生、修订全过程，可实现DRG事前、事中、事后管理，但医疗机构需注意甄别偏差数据，确保临床行为规范，提高DRG管理主动性。

Real-Time Grouping Management Based on Hospital-Level DRG Grouped Medical Data Knowledge Base

A real-time grouping scheme was proposed in order to further stimulate the effectiveness of Diagnosis Related Groups (DRGs) in the management of medical resources and the standardization of diagnosis and treatment behavior. According to the clinical diagnosis, treatment plan and other diagnosis and treatment data of grouped discharged patients in the hospital, the knowledge base of DRG grouped diagnosis and treatment data was constructed by means of big data statistics, and the four-level real-time grouping method of patient diagnosis and treatment grouping, department discharge grouping, medical record coding grouping and medical insurance review grouping were proposed. The effect after practice was obvious. The knowledge base of DRG grouped diagnosis and treatment data conformed to the actual situation of the hospital. The real-time grouping scheme ran through the whole process of the generation and revision of the main diagnosis of patients, which can realize the management of DRG before, during and after the event. However, medical institutions should pay attention to the screening of deviation data, maintain the norms of clinical behavior, and improve the initiative of DRG management.