基于DRGs绩效平台未入组病例原因分析

目的 分析某儿童医院住院病例在DRGs绩效评价平台中未入组原因,提高DRGs入组率.方法 医院2017年1月1日-2019年12月31日间住院病案首页数据经绩效评价平台进行DRGs分组处理,对未入组的每份病例根据平台错误提示与编码规则、诊断书写、病案首页填写等要求进行深入分析,明确未入组原因.结果 共上传住院病案首页数...

Analysis on the Causes of Unenrolled Cases of DRGs Performance Evaluation System

Objectives To analyze the causes of unenrolled cases in a children’s hospital by DRGs performance evaluation system, and improve the enrollment rate of DRGs. Methods The data of front page of discharged patients from 2017 to 2019 was derived, and grouped by DRGs performance evaluation system, selected and analyzed unenroll case by the error of DRGs performance evaluation system and coding rules, diagnostic writing, front page filling, to find out the existing problem. Results The number of discharged patients was 44103, and unenrolled cases was 151(0.34%). The specific reasons for that were the confusion of the coding dictionary used in the hospital which induced the non-standard coding errors(73 cases), the admission weight of neonatal is missing or older than 28 days infants using neonatal diagnosis caused mismatches in neonatal diagnosis(42 cases), the disease diagnosis and/or surgical operation inconsistent with the child’s gender resulted in gender inconsistency(28 cases), unsuitable selection of main diagnosis and improper grouping of DRGs evaluation system produced invalid main diagnosis(8 cases). Conclusions To take the specific reasons of unenrolled cases as the guidance, carding to usual fault reasons, establish library, department professional strengthening clinical training, enhance the level of medical record coding and perfect the function of information system, to establish hospital quality of medical record front pages and the assessment results and determination of promotion, performance appraisal, year-end bonus, such as management link rewards and punishment mechanism, thus to strengthen the quality of hospital medical record front page and effectively improve the DRGs into the group rate.