摘要
目的规范建立ICD-10疾病分类标准名及代码与常用临床诊断名称或表述映射规则，系统性改进DRGs分组关键数据质量，客观评估诊断数据质量对DRGs分组及相关指标的影响。方法扩展临床诊断同义词或近义词概念词典，建立ICD-10疾病分类字典库规范化维护流程与映射标准。调整DRGs病种构成对疾病分类的影响程度，比较标化前后主要诊断分类一致率、DRGs分组一致率以及DRGs分组的方差减少量（RIV）与病例组合指数（CMI）等指标的变化情况。结果选取某妇幼医院2012年至2013年（72005例）和2014年至2015年（77705例）的妇、产、婴专科数据进行改进前后比较分析。改进前编码一致率为59．60％，改进后标化一致率提高至66．38％；改进前DRGs分组一致率为69．30％，改进后标化一致率提高至88．00％；改进前费用RIV为0．515，改进后0．576；改进后医疗机构不同院区间CMI值变化更趋合理化。结论诊断质量控制与改进项目，提高了DRGs分组数据质量，在此基础上计算的RIV、CMI等指数，更科学地反映临床诊疗复杂性，对建立更透明、公平、合理的价值导向预付机制有一定的作用。
Objective To regulate standardized ICD-10 case classification name and coding, and common clinical diagnosis name or expression of mapping rules, to systematically improve the quality of DRGs key data, and to assess the impact of medical diagnostic data quality on DRGs and the indicators based on the DRGs. Methods Extension of the glossaries of clinical diagnosis synonyms or near-synonyms, and establishment of a standardized maintenance procedure of ICD-10 dictionary. Adjustment of the impact extent of DRGs disease makeup on case classification, comparison of the consistency of principal diagnosis classification, and the consistency of DRGs grouping, as well as changes of such indicators as DRGs grouping reduction in variance （ RIV ） and case mix index （ CMI ）. Results Data of the obstetrics, gynecology and pediatrics disciplines of a maternity and children hospital from 2012 to 2013 （72 005 cases） and 2014 to 2015 （77 705 cases） were chosen for prior-after comparison. The encoding consistency rate was 59.60% before the improvement, with the improved standardized consistency rate rising to 66. 38% afterwards; beforehand the DRGs grouping consistency rate was 69. 30%, with the improved standardized consistency rate rising to 88.00% afterwards; beforehand the cost RIV was 0. 515, with the cost RIV rising to 0. 576 afterwards; the CMI variations of individual campuses of healthcare institutions appear more reasonable. Conclusions Diagnostic quality control and improvement project can improve the data accuracy of coding. This empowers the RIV and CMI indexes calculated on such basis to better describe the complexity of clinical settings, conducive to establishing a value-oriented prepayment system which is more transparent, fair and reasonable.
作者
章莹
韩栋
徐金龙
张哲军
王思琪
魏凌云
Zhang Ying Han Dong Xu Jinlong Zhang Zhejun Wang Siqi Wei Lingyun(Department of Medical Record, Guangdong Women and Children Hospital, Guangzhou 510010, China)
出处
《中华医院管理杂志》
CSCD
北大核心
2017年第4期285-288,共4页
Chinese Journal of Hospital Administration
基金
广东省省级科技计划项目（2014A040401042）
