疾病诊断相关分组视角下缺陷病案首页的改进效果分析

顾晓敏; 陈逸楠

doi:10.16766/j.cnki.issn.1674-4152.004388

疾病诊断相关分组视角下缺陷病案首页的改进效果分析

doi: 10.16766/j.cnki.issn.1674-4152.004388

顾晓敏^,,
陈逸楠

湖州市中心医院病案管理中心，浙江湖州 313000

基金项目:

国家卫生健康委医院管理研究所2023年医疗质量(循证)管理研究一般项目 YLZLXZ23G111

浙江省医药卫生科技计划一般项目 2023KY1173

详细信息

通讯作者:
顾晓敏，E-mail：516498515@qq.com

中图分类号: R197.323 R195.3
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- 文章访问数: 6
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- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-02-16
- 网络出版日期: 2026-04-11

Analysis of the improvement effect of defective medical record homepage from the perspective of diagnosis related groups

GU Xiaomin^,,
CHEN Yinan

Medical Record Management Center of Huzhou Central Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的分析病案首页填写质量对疾病诊断相关分组(DRGs)及医保费用结算的影响，探讨质量控制措施改进病案首页缺陷的效果，从而提高医院的DRG管理水平。方法本研究采用回顾性分析方法，抽取湖州市中心医院2022年出院患者中有缺陷的病案首页8 776份。根据质控前后的数据，分析病例入组率、DRG分组数、费用消耗指数、时间消耗指数及支付差额等指标的差异。结果质控后，病例入组率从91.12%(8 014例)提高至99.78%(8 776例)，正常倍率组病例增加至7 650例，占比87.17%，高倍率组病例减少至524例，占比5.97%。DRG分组数增加了19组，病例组合指数下降了0.22，费用消耗指数和时间消耗指数分别从1.14和1.21降至1.01和1.02。支付差额也有所下降，特别是消化系统疾病支付差额从-221.69万元降至-16.92万元。统计结果显示，质控前后的各项指标比较差异均有统计学意义(P＜0.05)。结论引入质控措施显著提高了病案首页的填写质量，优化了病例分类和资源配置，降低了医疗费用和时间消耗，提高了DRG管理水平和医疗服务效率。这些措施在实际应用中有效提升了医院的整体管理和医疗质量，具有重要的参考价值。未来应继续深化质控措施，探索更多创新管理策略，以进一步提升医疗服务质量与效率。
- 疾病诊断相关分组 /
- 病案首页 /
- 改进效果 /
- 医保费用
Abstract: Objective To analyze the impact of the quality of filling in the medical record homepage on the grouping of diagnosis related groups (DRGs) and the settlement of medical insurance expenses, and to explore the effect of quality control measures on improving defective medical record homepages, thereby enhancing hospital DRG management. Methods We conducted a retrospective analysis of 8 776 inpatient discharge records with defects in the medical record homepage from Huzhou Central Hospital in 2022. Using data before and after the quality-control (QC) intervention. We compared differences in key indicators, including case inclusion rate, number of DRG groups, cost consumption index, time consumption index, and reimbursement balance. Results After QC, the case inclusion rate increased from 91.12% (8 014 cases) to 99.78% (8 776 cases). Cases in the normal-multiplier group rose to 7 650 (87.17%), while those in the high-multiplier group decreased to 524 (5.97%). The number of DRG groups increased by 19, and the case-mix index decreased by 0.22. The cost and time consumption indices declined from 1.14 and 1.21 to 1.01 and 1.02, respectively. The reimbursement balance also improved, most notably in digestive system diseases, where it shifted from CNY -2.216 9 million to CNY -0.169 2 million. All pre- vs. post-QC comparisons were statistically significant (P < 0.05). Conclusion The introduction of quality control measures significantly improves the quality of filling in the medical record homepages, optimizes case classification and resource allocation, reduces medical expenses and time consumption, and improves DRG management and medical service efficiency. These measures effectively enhance the hospi-tal's overall management and medical quality of practice, providing valuable references. Future work should continue to deepen quality control measures and explore more innovative management strategies to further improve the medical service quality and efficiency.
- Diagnosis related groups /
- Medical record homepage /
- Improvement effect /
- Medical insurance expenses

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表 1 8 795份病例质控前后基本情况比较

Table 1. Comparison of 8 795 cases before and after quality control

时间	入组率 (%)	高倍率组 [例(%)]	DRG组数 (x±s, 组)	CMI (x±s)	费用消耗指数(x±s)	时间消耗指数(x±s)
质控前	91.12(8 014/8 795)	1 155(13.13)	696.00±25.12	1.32±0.20	1.14±0.18	1.21±0.19
质控后	99.78(8 776/8 795)	524(5.97)	715.00±18.54	1.10±0.15	1.01±0.12	1.02±0.14
t值			3.975	3.664	2.974	3.245
P值			0.001	0.002	0.033	0.015

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表 2 不同DRG分组质控前后差异比较[例(%)]

Table 2. Comparison of differences before and after quality control of different DRG groups [cases (%)]

组别	外科		非手术室操作		内科		合计
组别	质控前	质控后	质控前	质控后	质控前	质控后	质控前	质控后
正常倍率	2 034(84.36)	3 866(86.90)	864(81.43)	1 406(94.49)	3 388(74.59)	2 378(83.76)	6 286(78.44)	7 650(87.17)
高倍率	209(8.67)	320(7.19)	151(14.23)	61(4.10)	795(17.50)	143(5.04)	1 155(14.41)	524(5.97)
低倍率	168(6.97)	263(5.91)	46(4.34)	21(1.41)	359(7.90)	318(11.20)	573(7.15)	602(6.86)
χ²值	8.362		108.461		253.149		337.473
P值	0.015		＜0.001		＜0.001		＜0.001

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表 3 质控前后MDC前十病例数盈亏情况对比

Table 3. Comparison of profit and loss of MDC top 10 cases before and after quality control

MDC编码	MDC名称	质控前		质控后
MDC编码	MDC名称	例数	支付差额(万元)	例数	支付差额(万元)
MDCG	消化系统疾病及功能障碍	1 397	-221.69	1 432	-16.92
MDCR	骨髓增生疾病和功能障碍，低分化肿瘤	1 244	-254.83	1 415	-194.19
MDCE	呼吸系统疾病及功能障碍	1 058	-234.70	1 015	-33.75
MDCF	循环系统疾病及功能障碍	614	-342.23	582	-47.99
MDCI	肌肉、骨骼疾病及功能障碍	591	-173.79	976	7.24
MDCL	肾脏及泌尿系统疾病及功能障碍	523	-79.20	509	-39.28
MDCH	肝、胆、胰疾病及功能障碍	444	-110.23	405	-100.36
MDCB	神经系统疾病及功能障碍	439	-356.67	294	-180.55
MDCJ	皮肤、皮下组织及乳腺疾病及功能障碍	290	-64.46	372	-16.96
MDCM	男性生殖系统疾病及功能障碍	275	-60.97	277	15.48

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