[1]曾雪琴,黄 伟,于 伟.DIP核心病种分类管理模式构建与实践[J].卫生经济研究,2023,40(10):66-69,73.
　ZENG Xueqin,HUANG Wei,YU Wei.Construction and Practice of DIP Core Disease Classification Management Model[J].Journal Press of Health Economics Research,2023,40(10):66-69,73.
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DIP核心病种分类管理模式构建与实践
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年10期
页码:
66-69,73
栏目:
筹资与支付
出版日期:
2023-09-28

文章信息/Info

Title:
Construction and Practice of DIP Core Disease Classification Management Model
作者:
曾雪琴1; 黄 伟2; 于 伟3
1.西南医科大学人文与管理学院，四川 泸州 646000
2.四川省泸州市医疗保障事务中心，四川 泸州 646000
3.西南医科大学附属医院，四川 泸州 646000
Author(s):
ZENG Xueqin;  HUANG Wei;  YU Wei
School of Humanities and Management, Southwest Medical University, Luzhou Sichuan 646000, China
关键词:
DIP; 核心病种; 分类管理; 监管
Keywords:
DIP;  core diseases;  classification management;  supervision
分类号:
F840.684
文献标志码:
B
摘要:
目的：基于DIP核心病种ICD编码质量和临床诊疗行为，探索构建DIP核心病种分类管理模式。方法：对四川省泸州市DIP核心病种（3 179个）及其病例（1 156 035例）进行疾病诊断和手术操作编码核查，分析其编码异常类型及原因。结果：该市DIP核心病种的病例异常率为5.14%，病种异常率为5.66%，其中主要诊断选择错误涉及病种最多（83个，2.61%），主要手术操作漏报涉及病例最多（30 394例，2.61%）；最终构建以正常组、监管组、歧义组为监管维度的DIP核心病种分类管理模式。结论：提高病案数据质量，建立病种动态调整与纠偏机制，有利于提高医保基金监管精准性，确保医保付费公平有效。
Abstract:
Objective To explore the construction of a classification management model of DIP core diseases based on the ICD coding quality and clinical diagnosis and treatment behavior of DIP core diseases. Methods The disease diagnosis and surgical procedure codes of the core DIP diseases(3 179 cases) and their cases(1 156 035 cases) in Luzhou City, Sichuan province were verified, and the types and cau-ses of abnormal coding were analyzed. Results The abnormal rate of DIP core disease cases was 5.14%, and the abnormal rate of disease types was 5.66%. Among them, the main diagnostic selection errors involved the most disease types(83, 2.61%), and the main surgical ope-ration omissions involved the most cases(30 394, 2.61%). Finally, a DIP core disease classification management model with the normal group, the supervision group and the ambiguous group as the supervision core was constructed. Conclusion It is necessary to improve the quality of medical record data and establish a dynamic adjustment and correction mechanism for disease types, which is conducive to improving the accuracy of medical insurance fund supervision and ensuring fair and effective medical insurance payments.

参考文献/References:

[1] 许速，谢桦，崔欣，等.基于大数据的病种分值付费的原理与方法[J].中国医疗保险，2020（9）：23-28.
[2] 李会玲，曹蕊，许凤娟，等.哈尔滨市医保结算中DRG分组测算的问题分析[J].中国卫生经济，2021，40（8）：37-40.
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更新日期/Last Update: 2023-09-28