基于DRG付费制度改革下病案首页校验规则设定研究

Case Home Verification Set Rules Study Based on the DRG Payment System Reform

摘要: 在医保支付方式不断深化改革下，病案首页作为DRG付费模式的主要数据来源显得愈发重要，对病案首页的初期质量控制采取“设定校验规则”成为当下提高病案首页信息准确性的一种主流方式，但一昧增设简单的校验远不能满足日常的病案首页管理工作，且易造成既定校验与诊疗事实相悖的情况，缺少对病案首页各类校验在实际应用中的逻辑分析、系统分类和辩证思考。通过文献分析、实地调研和实证研究等方式，系统地梳理了病案首页校验规则的现状与问题，在既定必填控制项和逻辑校验功能的基础上，不断整合、研判病案首页各类校验规则的可行性，以降低病案首页质控的出错率、减少时间成本、提高工作效率，为临床医生的病案首页填写提供有力支持，为医院在DRG付费制度改革下病案首页的整体质量提供有效保障。

Abstract: Under the deepening reform of medical insurance payment methods, the Home of medical records as the main data source of DRG payment mode is becoming more and more important, and the initial quality control of the Home of medical records has become a mainstream way to improve the accuracy of the information on the Home on medical records, but the addition of simple verification is far from satisfying the daily management of the Home of medical records, and it is easy to cause the situation that the established verification is contrary to the facts of diagnosis and treatment, and there is a lack of logical analysis, systematic classification and dialectical thinking of various verification of the Home of the medical records in practical applications. Through literature analysis, field investigation and empirical research, this paper systematically sorts out the current situation and problems of the verification rules of the home of the medical record, and continuously integrates and judges the feasibility of various verification rules of the Home of the medical record on the basis of the established mandatory control items and logical verification functions, so as to reduce the error rate of the relevant personnel on the Home of the medical record, reduce the time cost and improve the work efficiency, provide strong support for the clinicians to fill in the Home of the medical record, and provide effective guarantee for the overall quality of the Home of the medical record under the reform of the DRG payment system.