目的 通过分析某三甲综合医院QY病案产生的原因,提高病案首页填报质量和DRG入组准确率.方法 调取某院院内DRG分组平台中2019年7月1日-2020年6月30日住院病案首页DRG预分组为QY的病案161例,组织病案质控医师和高年资编码员,通过查阅病案资料得到编码不入组原因,采用Excel 2010对数据进行统计分析并绘制帕累托图.结果 产生QY病案原因类型:主要因素为DRG分组规则缺陷及主要诊断错误,构成比分别为32.3％和26.09％;一般因素为同次住院治疗多种疾病,构成比为23.6％;次要因素为主要手术操作错误及诊断与手术操作同时错误,构成比分别为13.04％和4.97％.结论 QY病案产生的原因是多方面的,医院要加强对医师和编码员的培训工作,建立病案首页数据质控长效机制,从而提高病案首页数据质量、减少或避免QY病案的发生、进一步提高DRG入组准确率.

结合疾病诊断的临床指南,对比分析ICD-11中脑梗死相关内容与现行ICD-10之间的编码差异.ICD-11对脑梗死进行了改变和添加,脑梗死作为脑血管病不再分类于循环系统疾病,而被分类于神经系统疾病章节,诊断术语改为缺血性脑卒中,分类轴心与临床应用最为广泛的脑梗死TOAST病因分型一致,病变部位和侧性可以通过后组配的组合式编码形成的簇编码得以体现,对于疾病的表达更加精细化,更适合医学的发展及管理需求.

目的 结合疾病诊断的临床指南,对比分析明确ICD-11中糖尿病相关内容与现行ICD-10之间的编码差异,希望为ICD-11的推广应用和国内卫生信息化建设提供借鉴和参考.方法 用表格对糖尿病类型及并发症编码进行映射,比较ICD-11与ICD-10分类体系中存在的差异.结果 糖尿病类型在ICD-10与ICD-11中都是类目的分类轴心,ICD-11对糖尿病进行了改变和添加,取消了星剑号双重分类系统,并发症在ICD-11中被分类在不同章节,添加了主干码、扩展码、后组配等新概念.结论 通过对比糖尿病在ICD-10与ICD-11中的差异,学习探讨ICD-11中章节内容、编码组配形式、信息更新等方面的变化,在实践中不断学习,为ICD-11的推广应用做好准备工作.

目的 分析某院噬血细胞综合征患者构成及住院费用变化情况,探讨进一步降低患病率和合理控制费用提提供参考依据.方法 收集整理北京市某三甲综合医院2015年1月1日-2020年12月31日收治的主要诊断为噬血细胞综合征患者,对其性别、患者来源地区、年龄、住院天数、治疗类型、离院方式、住院费用等进行回顾性分析,通过Wilcoxon秩和检验、Kruskal-Wallis H检验和Cox-Stuart趋势存在性检验比较分析不同特征患者住院人次及费用情况.结果 6年间不同特征噬血细胞综合征患者呈持续增长模式,外地患者占92.54％,平均住院费用35975元;18岁～40岁患者占53.15％,平均住院费用40279元;1天～7天患者占51.94％,平均住院费用13237元;非初治患者占65.95％,初治患者平均住院费用43812元;医嘱离院患者占88.96％,死亡患者平均住院费用98486元.噬血细胞综合征患者平均住院费用呈波动性增长趋势,在2016年为45970元最高,2020年药品费用构成比和材料费用构成比最低占12.9％和4.6％.结论 对于噬血细胞综合征患者,应加强地方医疗建设,加大青少年和中年患者的健康教育,提高病床周转率和医疗服务效率来降低患者住院费用减少患者家庭经济负担,争取实现早诊断早治疗,提高噬血细胞综合征患者生存率.

目的 了解某院住院患者术后死亡原发系统疾病和死因构成,为医院加强围手术期管理提供数据支持.方法 从某三甲综合医院住院病案首页信息系统中检索2018年1月1日-2020年12月31日住院手术后死亡的患者118例,对主要诊断、年龄、性别、出院日期、入院途径、出院科室、手术方式、死亡原因进行系统回顾、分类整理和归纳总结,采用Friedman检验和Wilcoxon signed-rank检验进行分析.结果 某院期内死亡总数1335例,术后死亡病例118例,术后死亡病例占比从2018年的10.98％下降到2020年的7.84％,Friedman检验的P=O.024,≥65岁年龄组占比为69.49％,通过Friedman检验的P=0.011,两者P＜0.05,差异存在统计学意义.术后死亡原发系统疾病由循环系统、肿瘤、消化系统、损伤和中毒及其他系统疾病组成;死亡原因中发生并发症的占比为39.83％,术后原发病进行性加重占比为36.44％;≥65岁组术后并发症占比为45.12％;术后死亡病例共涉及10个科室;非预期进入ICU的34例分布在7个科室;非计划再次手术的6例涉及3个科室.结论 研究数据显示术后死亡病例在3年间逐年下降,≥65岁患者最多;术后死亡系统疾病有5种;死亡原因以≥65岁组发生并发症和原发病进行性加重为主;主要术式集中在神外科和心外科,多为难度大和危险程度高的手术,需提高术者的责任感,降低不良事件发生率.

近年来心脏瓣膜病的主要病因及受累人群发生了变化,该文根据世界卫生组织官网提供的ICD-11目录搜索工具与卫健委提供的国际疾病分类第十一次修订本(ICD-11)中文版目录,分析心脏瓣膜病在ICD-11中分类轴心与编码形式的变化.与ICD-10相比,心脏瓣膜病在ICD-11中的分类层级有所改变,根据医学发展减少了风湿性因素,分类层级先是瓣膜类型,然后是疾病生理学特征,最后是病因;该病的临床表现、严重度和发病时间通过后组配扩展码的组合式编码形式进行了更加完整的体现,弥补了ICD-10的不足.ICD-11更加贴近临床,可以为临床提供更加精细的健康数据.

目的:在“结构-过程-结果”评价理论指导下,构建体现三级医院功能定位的门诊医生医疗质量评价指标体系.方法:通过文献研究、政策分析和专家访谈构建三级医院门诊医生服务质量评价指标体系框架;采用德尔菲法对指标的重要性、可操作性和敏感性进行打分,筛选指标并计算权重.结果:德尔菲法咨询的14位专家的专业领域涉及医院管理、卫生管理和临床医学方面,平均专业年限为12.79年;两轮咨询的专家积极系数均为100％,专家权威系数大于0.7,专家协调系数Kendall W的范围为0.14～0.39.最终构建的评价指标体系涵盖4个一级指标,16个二级指标,35个三级指标.结论:构建的指标体系可量化,提示门诊医生服务质量体现在服务的结构、过程、结果全过程,体现了不同科室、不同职称门诊医生服务对象和提供服务内容的差异与医疗质量的可比较.

Objective To analyze the incidence,risk factors,clinical characteristics and pregnant outcomes of perinatal pulmonary embolism(PPE).Methods Clinical data of eight patients who were admitted to Beijing Friendship Hospital of Capital Medical University for PPE from January 2006 to March 2016 were collected.General condition,symptoms,laboratory examinations,images,treatments and outcomes of these patients were analyzed retrospectively.Results The ten-year incidence of PPE was 0.029％ (8/27 560) in this hospital.Among the eight cases,two cases were diagnosed in the first trimester,and treated successfully by thrombolytic therapy.But one of two cases stopped growth,while the other one was premature labor.There were one case in the third trimester who had successful anticoagulant therapy and five cases in the postpartum period after cesarean delivery.Among the five cases,three cases were recovered after anticoagulant therapy,one case was recovered after thrombolytic therapy and one case died.All of the eight patients were immobilized before the onset of PPE,and five of them were diagnosed after cesarean section.Four out of the eight patients were obese.Five patients had three or more high-risk factors for pulmonary embolism and the other three had two.Conclusions It is necessary to pay close attention to gravidas who have two or more high-risk factors of PPE due to its fatal outcome.

This paper introduces the clinical features and pathogenesis of postmenopausal ovary syndrome in detail. According to the principle of international classification of diseases, and combined with typical cases, the errors of the disease in the choice of primary diagnosis are discriminated, and the adverse effects of this error can be discussed. Discuss how to select the main diagnosis correctly. It is an abnormal sign which is often used as an indication for surgical exploration. Classification should be based on further examination and treatment to select the correct primary diagnosis.

Objective To understand the influence of prescribing and dispensing experimental unit to hospitalization expenses and the development trend in a public hospital in 2012, and to explore primary expense of hospitalization fee structure changes.Method Collect hospitalization expenses of medical insurance patients from 2011 to 2014, using the new grey correlation analysis method to quantitative analyzing cost structure. Through calculating structure changes and changes values, analyzing the characteristics of the fee structure changes.Results The in-patient number and Total hospitalization cost Increased year by year. The sequence of degree of association of Hospitalization expenses in each project with the total hospitalization expenses is materials expenses, medicine expenses, Inspection fee and other fees. Hospitalization fee structure change characteristic for four years: medicine expenses showed a downward trend, the annual structure changes value is -14.4.materials expenses, Inspection fee and other fees showed an increasing trend. Annual structure change values were 8.2, 2.8 and 3.4 respectively. The increase of the cost of materials accounted the most obvious.Conclusions After the reform pilot, medicine expenses of medical insurance patients have effectively controlled. But the significant increase of materials expenses has become the main factors affecting hospitalization cost increasing. Need to adopt the reasonable and effective measures to control abnormal growth of cost of materials.

Objectives Through conducting analysis on the payment refusal of medical insurance in outpatient internal medicine department, to provide reference basis to reduce the payment refusal and promote the reasonable treatment. Methods The data about the payment refusal in all the outpatient internal medicine departments in a hospital from 2012 to 2014 was collected, and made a descriptive analysis on the refusal situations. Results There were 4854 cases of payment refusal in the outpatient internal medicine departments in a hospital from 2012 to 2014, and the total expense was 159000 yuan. The heart center got the most admitted patients which was 2226 cases, and also got the most refusal expense which was 45214 yuan. The reasons for payment refusal mainly contributed to cumulative prescribing excess and single prescribing excess, which accounted for 80% and 15% respectively. Conclusions By analyze the situation of payment refusal of medical insurance in outpatient internal medicine department, we could make improving measures such as formulating medical insurance management rules timely as well as dynamic connection to medical insurance policy by multiple departments, which could decrease the occurrence of payment refusal of medical insurance effectively.

医保服务医师管理制度将医保管理从经验化向科学化和精细化推进,将医保服务监管从定点医疗机构延伸到医师个人.自医保服务医师试点以来,医院门诊拒付金额及拒付人次比实施前有明显下降,医师自律性大大提高.医疗机构医保管理部门通过采取医师准入、政策培训、约谈预警及有效沟通等措施,使医保服务医师为医保患者服务的观念明显增强,诊疗行为更加规范,医保基金支付更趋合理.

Objective Summarize the positive effect of delicacy management to promote the reform of Medicare payment reform,gradually discover,establish and improve the medicare management system in hospital.Methods Collect the medical expenses data of Beijing medicare patients in our hospital from January 2012 to December 2013.Analyse the trends of medicare funds, attendances, average expense and drugs proportion.Results Compared with 2012,in 2013 Outpatient and emergency medicare attendances increased 12.82%, hospitalized medicare attendances increased 4.65%;outpatient and emergency medical insurance fund increased 4.52%, hospitalized medical insurance fund increased 2.61%;outpatient and emergency medicare average expense fell 6.97%,hospitalized medicare average expense fell 0.99%;outpatient and emergency medicines cost proportion fell 13.98%,hospitalized medicines cost proportion fell 17.95%.Conclusion Delicacy management can ensure the completion of the total prepaid task successfully,rational use of medical insurance fund,provide valuable experience for medicare payment reform.

Objective To investigate the frequency and characteristics of hepatopancreatobiliary(HPB) complications among patients with Crohn`s disease(CD) and ulcerative colitis(UC).Methods A total of 606 inflammatory bowel disease(IBD) patients(68 CD,538 UC) treated by our hospital between 1990 and 2010 and 606 healthy subjects matched for age,sex,and body mass index(BMI) were enrolled.Frequency of HPB complications including gallstone disease(GD),nonalcoholic fatty liver disease(NAFLD),primary biliary cirrhosis(PBC),primary sclerosing cholangitis(PSC),autoimmune hepatitis(AIH),and chronic pancreatitis(CP) were compared between the IBD group and the control group.OR,95% confidence intervals(95%CI),and P values were calculated.P0.05 was considered statistically significant.Results The frequency of gallstone disease was 51.47%(35/68) among CD patients[OR=10.96,95%CI(4.181,28.724)] and 34.01%(183/538) among UC patients[OR=5.79,95%CI(4.053,8.264)],significantly different from that among the control group(P0.01).The frequency of NAFLD was 64.71%(44/68) among CD patients[OR=8.56,95%CI(3.854,18.994)] and 69.33%(373/538) among UC patients[OR=8.41,95%CI(6.378,11.084)],significantly different from that in the control group(P0.01).Screening for IBD in Patients with uncommon HPB diseases showed that the frequency of PBC,PSC,AIH,and CP were 2.25%(7/311),4.49%(4/89),3.33%(2/60),and 0.93%(2/213),respectively.Conclusion GD and NAFLD are among the most common extraintestinal manifestations of IBD,especially in patients with CD or UC.We suggest that the diseased of IBD and HPB be reciprocally screened under a normalized system.

目的了解介入技术的具体操作方法,做出准确的手术操作编码。方法对常见的介入方法从操作方法及主导词的选择进行分析。结果及结论介入疗法根据不同的解剖部位和治疗目的,其对应的手术操作编码也不同。

Objective To deepen the understandirg of the clinical and etiological features of postopera-tive nosocomial infections (NI) in the surgery department. Methods Eighty-four cases of postoperative NI in the surgery department of our hospital during 2007-2008 were analyzed. Results Of the 84 cases investiga-ted,in our hospital, the department of general surgery and urinary surgery and neurosurgery showed a high in-cidence of NI ;the respiratory infection accounted for the majority of all the NI cases. Invasive work and intra-operative general anesthesia and the admission time more than one month were the most common reasons for NI;infection rate of G~- bacilli was 49. 58%, G~+ coccobacteria was 35.77%, fungus was 14. 63%. Con-clusion To upgrade the medical staffs' understanding on how to prevent and control postoperative NI in the surgery department, and to reduce the rate of postoperative NI in the surgery department by taking all-around methods are necessary.

Objective To evaluate the effect of systemic health education on the postoperative quality of life in patients with arteriosclerosis obliterans in lower extremity.Methods One hundred and five patients with arteriosclerosis obliterans in lower extremity were assigned to routine health education condition and systematic health education condition by a specified nurse with health education handbook.Result The quality of life in the experimental group was significantly higher than that of the control group(P0.01).Conclusion Systemic health education can improve the postoperative quality of life in patients with arteriosclerosis obliterans in lower extremity.

目的 探讨癌症患者心理困扰程度及其相关因素,为实施心理护理提供依据.方法 采用描述性研究设计,应用患者基本资料调查表和癌症患者心理困扰管理调查问卷作为心理困扰程度及相关因素的评估工具,对100例癌症患者进行评估分析.结果 100例癌症患者均有不同程度的心理困扰,视觉模拟尺度表得分平均为4.50±2.50,心理困扰程度为中重度.患者的性别、年龄、化疗次数对癌症患者的心理困扰程度有显著影响.心理困扰原因分析显示,心理困扰的原因多为躯体及情绪方面的问题.结论 大部分癌症患者具有中重度心理困扰,应根据患者心理困扰的相关因素及原因进行个体化的心理干预,从而降低其心理困扰程度.

报告了应用血管内支架治疗37例锁骨下动脉窃血综合征患者的术后护理。术后严格穿刺肢体制动,密切观察穿刺点有无渗血,观察穿刺肢体皮肤的颜色和温度。对于术前合并高血压、糖尿病和脑梗死的患者,还要监测血压、血糖等指标,同时注意做好并发症（动脉血栓形成、假性动脉瘤）的观察与护理。本组1例术后患肢肱动脉血栓形成,1例穿刺部位假性动脉瘤,经积极治疗和护理后均痊愈。

报告了微创旋切术治疗182例(216条患肢)下肢静脉曲张的术后护理.术后将患肢垫高20～30°以促进静脉回流,密切观察敷料有无血性渗出,并根据不同原因导致的疼痛给予不同处理.在并发症观察与护理方面,主要包括皮下血肿,肢体感觉异常、麻木,皮下硬结、感染.本组1条患肢出现切口感染,3条患肢出现小腿软组织蜂窝组织炎,8条患肢出现皮下硬结,12条肢体感觉异常、麻木,21条肢体出现皮下血肿,经积极治疗和护理后均痊愈.