目的 分析DRG分组中QY病例产生原因,减少不合理填报,以提高DRG的有效入组率.方法 调取某三甲综合医院 2021 年 10 月 1 日-2022 年 9 月 30 日北京地区医疗绩效服务平台上的DRG系统反馈的QY病例197例,通过描述性统计分析对原主要诊断和手术操作进行分析.结果 QY病例占整个病例DRG组的 0.26%,神经系统疾病及功能障碍组产生 QY 病例最多,占 43.15%;头颈、耳、鼻、口、咽疾病及功能障碍组和肌肉、骨骼疾病及功能障碍组,均占比 9.64%.因填报问题造成的QY 病例有 40 例,占比20.30%.结论 临床医师应熟悉病案首页填报原则,正确填报主要诊断和主要手术操作,编码员准确编码,DRG管理部门应根据反馈结果对分组细节不断地调整.

目的 为提升新生儿DRG分组的准确性,分别应用出生体重与入院体重作为入组条件,寻找入组依据.方法 数据来源于某市2016年1月1日-2020年12月31日出生天数<29 d的新生儿病案首页数据,应用CN-DRG分组方案(2018版)进行DRG分组,采用SPSS 24.0软件进行统计分析.结果 新生儿出生体重与入院体重均完整者占新生儿首页数据的77.1％;对于新生儿体重密切相关DRG组别,将出生体重与入院体重分别作为入组条件,入组一致及差异分别占97.6％及2.4％;对于入组存在差异的1821例,按照出生体重与入院体重入组准确分别占83.1％及8.5％,新生儿平均出生天数分别为6.00 d、18.85 d;对于新生儿平均出生天数≤7 d按出生体重入组准确,平均出生天数>14 d按出生天数构成及伴随问题选择入组体重;新生儿出生天数为8 d～14 d,出生体重与入院体重入组无差异.线性回归分析显示,出生体重回归系数绝对值>入院体重回归系数绝对值.结论 新生儿出生体重对DRG分组影响大于入院体重.应关注早产儿出生体重与入院体重变化,提升病案首页新生儿出生体重与入院体重的完整性,将合理体重作为DRG分组依据.

病案质量控制是医院医疗质量管理的重要组成部分,实时病案质控系统的构建和完善对保证病案质量有重要意义,特别是病案的内涵质控大多为人工进行,效率低同质化水平差,成本高是医院质量管理提升过程中的难点.由医务处牵头,与临床科室、信息中心共同制定电子病历包括住院病案首页的质控规则,包括形式质控和内涵审核两部分.集成医院多个业务系统数据,包括医院信息系统、影像归档和通信系统、实验室信息管理系统、计算机化病案系统,进行数据清洗,存储、整合,通过自然语言处理,建立基于人工智能的临床辅助决策系统,无缝衔接于电子病历系统中,实现电子病历实时、动态质控,达到质控关口前移,及时纠正病案缺陷,保证医疗质量和安全.

目的 分析联合多重影像评估的急性缺血性脑卒中临床特征.方法 联合多重影像评估首都医科大学宣武医院2014年1月至2018年12月收治的8441例急性缺血性脑卒中的发生占比、动脉血管病理改变、梗塞责任血管以及梗死机制.结果(1)男性发生占比高于女性(74.7％vs 25.3％;P＜0.001)而发病年龄则小于女性[(58.83±12.56)岁vs(63.37±13.27)岁;P＜0.0001],50～69岁为急性缺血性脑卒中发病高峰期(57.87％);(2)高血压、糖尿病和高脂血症为急性缺血性脑卒中主要危险因素,高血压为最常见危险因素(28.65％);(3)动脉粥样硬化(62.9％)是急性缺血性脑卒中动脉管壁最主要病理改变,也是最常见病因;39.2％的患者存在大脑中动脉狭窄闭塞;(4)67.49％的急性缺血性脑卒中发生于颅内动脉,前循环急性缺血性脑卒中发生率(58.33％)高于后循环(33.47％),差异有统计学意义(P＜0.0001);(5)动脉到动脉栓塞、局灶穿枝动脉闭塞,低灌注栓子清除障碍是急性缺血性脑卒中常见发病机制,其中动脉到动脉栓塞为主要发病机制.结论 多重影像评估的大样本的急性缺血性脑卒中的发病年龄、不同性别发病占比、动脉血管病理改变、责任血管发生率以及急性缺血性脑卒中发生机制对指导临床急性缺血性脑卒中的急救、二级预防、早期筛查及预防具有一定的指导作用.

目的 分析某院神经内科主要诊断为脑梗死的病案编码情况,从而提高神经内科的编码质量.方法 使用病案信息系统检索神经内科主要诊断编码(ICD-10)为脑梗死I63的病案2019年1月1日-2019年12月31日共2247份,利用图表形式,分析脑梗死I63.0-I63.9编码的使用情况.结果 2019年2247份病例中错误编码共337份,占总数的15.0％;其中脑梗死责任血管错误共120份,占总数的5.3％;脑梗死病因分型错误共135份,占总数的6.0％;脑梗死责任血管和病因分型错误共82份,占总数的3.7％.结论 脑梗死I63的临床诊断书写习惯与ICD-10编码名称不同,错误率高,编码员要熟练掌握脑梗死的分类轴心,了解脑梗死的责任血管和病因分型,以便更准确使用I63.0-I63.9,减少残余类目I63.9的使用.

随机抽取某医院2019年1月1日-2019年12月31日主要诊断为下肢动脉粥样硬化性闭塞症且进行手术操作的住院病案,重新审核其下肢动脉粥样硬化闭塞症的手术编码情况,以典型案例概括出编码中出现的4类错误类型:主要手术操作选择错误、遗漏其他手术操作、多编其他手术、医师手术记录不准确.通过典型案例归纳总结常见编码错误,分析导致编码错误原因,总结改进方法,加强编码员的手术分类专业知识的学习,加强对临床医师病历书写的培训,建立完善的编码质控流程,以提高下肢动脉粥样硬化闭塞症手术编码的准确性,进而提高手术编码质量.

目的 了解北京市医药分开综合改革前后外地患者住院比例和疑难危重疾病的构成变化.方法选取北京某 三甲综合医院2016年4月-2018年3月期间来院外地患者住院的病案首页数据,通过北京地区住院医疗服务绩效评价平台采集住院患者的DRGs分组结果,采用Excel 2007和SPSS19.0进行2组数据的卡方分析和双因素方差分析.结果 医改前后外地、本地患者进入有效DRGs的患者例数没有统计学差异(χ2=0.418,P>0.05);而医改后低权重组的总权重和大于医改前的总权重和(F=370.354,P<0.01);医改后手术DRGs组的总权重和高于医改前(F=24.626,P<0.01);医改后高权重手术DRGs的总权重没有增加,而低权重手术DRGs组的总权重增加(F=434.19,P<0.01).结论 北京市医药分开综合改革后,某院收治外地患者的病种结构改变,外地疑难、危重手术患者的增多.医院应有针对性地开展疑难危重病的诊治以及三四级手术,引导外地患者大病住院,小病在户籍居住地的就医趋势,促使各地患者理性就医.

目的 通过重点专科DRGs评价指标分析神经内科出院病例的指标差距和存在不足,为专科管理和改进提供数据支持.方法 分析某医院2017年1月1日-12月31日出院的神经内科病案9460份,将神经内科临床重点专科评价结果 细化分解到医院内部科室,计算各科室的病例数、CMI和时间费用消耗指数等DRGs指标的差距.结果神经内科出院病例涵盖DRGs诊断相关分组34组,CMI值1.24,低于全院病例水平;时间消耗指数0.84,费用消耗指数0.95,高于全院病例水平.结论 神经内科住院患者的住院天数、医疗费用与重点专科水平尚有差距,病种结构有待完善.

Objective To find out the present pediatrician allocation and the burden of diagnosis and treatment in Beijing,so as to provide evidence for effective allocation of pediatricians.Methods Data and indicators were selected from Beijing Health Comprehensive Statistical Information Platform,including Manpower Basic Information Survey of Beijing Health Institutions,Annual Report of Medical Institutions,Beijing Statistical Data on Health Work (Compendium),as well as Beijing Health and Family Planning Statistical Yearbook.The study dynamically analyzed the number of pediatricians,that of pediatricians per 1 000 children,that of outpatients and emergency patients per pediatrician and the number of discharges per pediatrician from 2013 to 2017.Descriptive analysis was carried out on the data.Results In 2017,the proportion of pediatricians accounted for 2.78％ of the total number of doctors in the city,the number of pediatric emergencies accounted for 6.47％ of the total outpatients and emergencies in the city,and the number of hospitalizations accounted for 5.70％ of the total discharge in the city.From 2013 to 2017,the number of outpatients and emergency patients per pediatrician increased by 40.58％,and the number of discharged patients increased by 36.70％.The proportion of hospitalization at tertiary hospitals increased from 80.2％ to 85.1％,and that in primary institutions decreased from 6.3％ to 1.7％.Conclusions The study found such setbacks in the allocation of pediatric medical resources in Beijing,as insufficient pediatricians,unreasonable allocation and excessive burden on pediatricians.We should strengthen the planning and construction of pediatric human resources,improve the training mode of pediatricians,improve the salary level of pediatricians,and ease the burden on pediatricians,so as to provide high-quality medical services for children.

Objective To analysis the influencing factors in costs of treating adults and children,and then to compare the difference of influencing factors between adults and children . Methods Using the medical record hompage data during, we built two hierarchical linear models to analysis the influencing factors in costs by 42 conditions with matching diagnosis related groups for adults and children. Results Gender, outway and the number of diagnoses had statistical significant to adults, where the contrary result to children; Hospital types had statistical significant to children, where the contrary to adults. The most significant factor influenced adults and children were "medicine & material expenses" (β adults=22754.94,βchildren=8815.84, all P＜0.001). There were higher in sequence of influencing factors than adults by children in the number of operations and age . Conclusion Influencing factors on costs between adults and children were differen. Currently Cost structure was inappropriate for it couldn't reflect the acctual medical resources needs for children. Shortening length of stay will improve resources use. Intensive study should be taken to age subdivision cause of the stronger correlation to children than adults in explaining hospital costs.

通过介绍医院病案无纸化归档的实施过程,探讨病案无纸化后存在的问题及管理方式的变革.病案无纸化归档的过程是一个全院各部门合作协调共同推进的过程,包括制度完善、科室协调、设备支撑、流程重塑等.无纸化归档的实施升级了病案管理人员的业务流程,减少了手工劳动,提高管理效率;改变了医师的书写习惯,方便医师对病案的查阅和使用,提高工作效率.但病案无纸化的管理流程目前也存在一些问题,仍需要对这些问题进行制度落实、清晰制定标准、重视患者信息的保护及使用科学的管理方法进行完善.

Objective to evaluate hospital medical service performance of the attending physician group of neurologyin 2016 using the DRGs method.Methods The study compared the medical service ability, efficiency and security among 17 groups of attending physicians. According to the Delphi method to establish the weight coefficient of each index, the study obtained scores of hospital medical service among the 17 groups of attending physicians. According to Twenty-eight Law, the study calculated cases, medical service efficiency and security in the same DRGs group among 17 groups of attending physicians. Results The top three comprehensive score of the attending physicians were, respectively, the attending physician P, F and E. And the lowest three of the attending physicians were M, N and Q. The attending physician C was the highest level of medical service in treating DRGs BR-23. Conclusion According to DRGs method, it's feasible, reliable and objective to evaluate the hospital performance service of the attending physician.

Objective To analyze and inspect the situation of operation coding of orthopaedic in our hospital. To improve the accuracy of orthopaedic operation coding. Methods Randomly selected orthopaedics medical record of our hospital beteen January 2015 to December 2016. The operation coding were analyzed. Results Six cases of coding error, accounted for 2.2%; 19 cases of coding omission, accounted for 7%; 10 cases of the operation name is inconsistent with the operation content, accounted for 3.7%; 7 cases of the operation contents were omitted, accounted for 2.6 %. Conclusion To improve the operation quality of hand coding, coding staff to enhance professional knowledge and clinical knowledge, develop the habit of reading medical records, and actively communicate with clinicians, seriously implement the ICD encoding principle; on the other hand strengthen the clinician ICD encoding knowledge training, standardize the operation name writing, improve the quality of medical records.

Objectives To conduct objective description on the hospital operations workload differences between two statistical calibers based on medical record front pages system and surgical anesthesia system, analyze the reasons, provide clues and basis for hospital managers, and put forward the corresponding countermeasures and suggestions.Methods To search operation data from the medical record front pages system according to the discharging time and surgical anesthesia system according to the operation time from the three departments of cardiology, orthopedic and pain from 1st to 31st January 2016, then match the operations workload data between two statistical calibers, then use describing statistical methods to analyze the differences.Results Main reasons of the surgery workload difference in cardiology, orthopedics and pain departments were separately changing department problems(83.33％), surgery places problems(53.16％) surgery classification problems(44.44％).Conclusions The main reasons for the differences included the type of patients, the way of time data collection, the inconformity classification between surgery and operation and the multiple surgeries of the patients. We should standardize the statistics so as to improve the accuracy of management decision.

Data were extracted from the Hospital Information System (HIS) and the medical record system, and the data were integrated with the VLOOKUP function of EXCEL. The data of constructing the associated field of clinical path in 2015 was selected and the problems were summarized. The source of data was from medical record information system of front pages and HIS of clinical pathway admittance data. To mainly use descriptive statistics analysis method, and the telephone interviews and focus group interview to determine the causes. In 2015, the percent of problems of number merging, false admission and discharge time was 1.94%, 0.17% and 0.04%. The reasons were as follows: the same patient with multiple numbers merging; after patients left the hospital the system left marks; the error of discharge time in midnight or misuse of the recall time of medical records. Multi system verification is for correction. Such data integration, not only to ensure that the quality of the data, but also improve the work efficiency, is conducive to the managers of the hospital timely grasp the clinical pathway implementation problems appeared in the process of, take effective measures, continuously improve the quality of hospital management.

Objective To acquire the general characters of elderly inpatients through an analysis on the situations of elderly hospitalized inpatients of a hospital from 2012 to 2014,so as to provide the basic data for hospital medical treatment work and service for the elderly inpatients.Methods The medical records data of hospitalized patients over the age of 60 years between 2012 and 2014 were collected,then conducted retrospectively analysis on the general situation,prevalence and mortality of elderly inpatients.Results There were 46906 elderly patients in total during the three years,and the proportion of the total number of patients was 35.2%.The main diseases of elderly patients were circulatory system disease,which accounted for 29.5% of all diseases,the causes of death in elderly patients with three diseases of circulatory system disease,respiratory system disease and tumor.Conclusions Circulatory system disease was an important risk factor affecting the elderly life and health,with the increasing of the medical needs of elderly patients,hospital should provide more reasonable and adequate medical services for elderly inpatients.

文章分析了医院质量监测系统(HQMS)实施过程中存在的问题,如数据接口不达标、首页填写不全及由于服务器和网络原因造成上报不成功等.针对这些问题,医政部门采取了有效措施,如职能部门的多方协调、病案信息录入过程的环节质控等,确保了数据质量.文章阐明了数据上报工作的重要意义,以及各部门在数据上报工作中所起到的重要作用.并强调各部门协调一致的工作是顺利上报的前提.

To investigate the composition and characteristics of appointment scheduling system and evaluate the pilot appointment scheduling system in Beijing hospitals in order to provide the evidence for the general application.Appointment system was constituted by appointment mode,appointment rule and scheduling rule.Beijing appointment scheduling system was integrated by advanced appointment mode,IBFI appointment rule and FCFA scheduling rule.According the characteristics of tertiary hospitals in Beijing,the advanced appointment mode and IBFI appointment rule were suitable for Beijing appointment system,however,FCFA scheduling rule had the potential for improvement,such as RTBG and ALTER.This combination will be more suitable for outpatient service status in tertiary hospital.

Objective To summarize the characteristic of the causes of death about elderly hospitalized patients.Methods In accordance with the principles of the International Classification and Encoding of Diseases,main diagnosis of patients in hospital was collected and summarized.Results The top three leading causes of death of elderly patients are circulatorysystem diseases,respiratory diseases and malignant tumors.Conclusion we should strengthen disease prevention and work hard to increase the character and medical treatment to decrease the outbreak rate and death rate of the old age.