信息技术在基于临床路径单病种的应用

目的:探索研究对医保基金进行有效的统筹控制使用的同时,保证医疗过程中的质量同样得到保障,即病种的质量和费用两方面得到有效控制。方法:结合南平市本地实际情况,从国家发布的1212种临床路径中遴选出病种,发动临床对其进行路径细化,利用信息技术在模拟平台中进行费用综合测算,分析费用构成情况。结果:在医疗机构大力配合下,将单病种付费结算结合临床路径进行实施,通过实施前后对比分析,平均医疗费用下降,并且通过临床路径有效避免了医疗不足的情况发生。结论:通过信息技术的应用,一方面按病种付费的医疗费用结算模式控制了医疗费用的不合理增长,减少医疗过度的情况发生,另一方面通过临床路径的控制来避免医疗不足的现象,这种费用、质量"双控制"的模式使医保、医院及病人在诊疗过程中实现三方受益。

The Application of Information Technology in Single Disease Based on Clinical Pathway

Objective:To explore the effective overall control of the medical insurance fund and ensure the quality of the medical process is also guaranteed,that is,the quality and cost of the disease are effectively controlled in two aspects.Methods:According to the local actual situation in our city,1212 kinds of clinical paths issued by the state were selected to select the disease species,and the path was refined,and the cost comprehensive measurement was carried out in the simulation platform by information technology,and the cost composition was analyzed.Results:With the cooperation of medical institutions,the payment and settlement of single diseases were carried out in combination with the clinical path,and the average medical costs were reduced by comparison and analysis before and after the implementation,and the lack of medical treatment was effectively avoided through the clinical path.Conclusion:Through the application of information technology,on the one hand,the medical cost settlement mode,which is paid by the disease type,controls the irrational growth of medical expenses,reduces the situation of excessive medical treatment,and avoids the medical shortage through the control of the clinical path.The"double control"model of the cost and quality makes medical insurance.Hospitals and patients can benefit from the three party in the process of diagnosis and treatment.