CN116759054A - DRG-based hospital performance management system and method - Google Patents

Abstract

The invention discloses a hospital performance management system and method based on a DRG, and relates to the technical field of medical information. The system comprises a medical information module for acquiring patient information and hospital configuration information; the patient information and the hospital configuration information are respectively put into files for management after being tidied; the DRG module is used for establishing a DRG standard library and providing DRG grouping information; the DRG grouping information comprises DRG codes, DRG names, DRG weights, DRG weight ladder standards and profit and loss ladder standards; the performance accounting module is used for performing performance calculation according to the DRG grouping information in the DRG module and the patient information in the medical information module; and the configuration module is used for configuring the data of the DRG module. The invention can standardize the operation flow of the hospital performance and realize the comprehensive management of the hospital performance.

Description

DRG-based hospital performance management system and method

Technical Field

The invention relates to the technical field of medical information, in particular to a hospital performance management system and method based on DRG.

Background

The statements in this section merely provide background information related to the present disclosure and may not necessarily constitute prior art.

The disease diagnosis related group (Diagnosis Related Groups, DRG) is mainly applied to medical service performance evaluation and medical insurance payment management in short-term hospitalization as a management tool. With the continuous reform of the medical and health system, the medical institutions focus on essential transformation, and at present, the improvement of benefits is pursued instead of simply pursuing income, and the service quantity, control and digestion cost are increased through a performance assessment scheme.

Therefore, under the original payment mode, the department can realize the income of the department through 'multi-doctor, multi-medicine and multi-project', thereby realizing the income of the performance prize. However, in the DRG payment method, high income cannot be brought by multiple projects. Because the DRG payment mode is the basis for calculating medical insurance payment based on the prepaid payment standard after the disease of the first page of the medical records is planted into the group, the income validation basis is greatly changed. In addition, if more projects are done, medical insurance which exceeds the regional average pre-control standard does not settle the buying bill, and loss can also occur. Therefore, the original performance scheme management system based on balance accounting performance or simply based on workload (RBRVS) cannot adapt to the existing DRG payment method.

Disclosure of Invention

Aiming at the defects existing in the prior art, the invention aims to provide a hospital performance management system and method based on DRG, which can standardize the performance operation flow and realize the comprehensive management of hospital performance.

In order to achieve the above object, the present invention is realized by the following technical scheme:

the first aspect of the present invention provides a DRG-based hospital performance management system, comprising:

the medical information module is used for acquiring patient information and hospital configuration information; the patient information and the hospital configuration information are respectively put into files for management after being tidied;

the DRG module is used for establishing a DRG standard library and providing DRG grouping information; the DRG grouping information comprises DRG codes, DRG names, DRG weights, DRG weight ladder standards and profit and loss ladder standards;

the performance accounting module is used for performing performance calculation according to the DRG grouping information in the DRG module and the patient information in the medical information module; the performance calculation comprises DRG operation performance fee calculation and DRG weight performance fee calculation;

and the configuration module is used for configuring the data of the DRG module.

Further, the patient information comprises a patient DRG code, a DRG medical insurance payment total, an discharge ward id, a discharge department id, a disease seed weight, a patient payment total and a DRG medical insurance reimbursement total; the hospital configuration information includes ward configuration information, department configuration information, and department point value tables.

Furthermore, considering the medical level of the hospital, classifying the disease seed weight grades according to the DRG weight scores and the score ratio of the hospital, and formulating a weight ladder standard and a profit and loss ladder standard based on the disease seed weight grades.

Further, the specific steps of calculating the DRG operation performance fee are as follows:

determining a medical department according to the discharge department id, and searching a corresponding profit and loss point value of the medical department by using a department point value table;

and multiplying the surplus and the deficit with the surplus and deficit point value of the corresponding ladder according to the surplus and deficit ladder standard to obtain the DRG operation performance fee of the medical department.

Further, the DRG medical insurance payment sum in the patient information is searched, and the patient payment sum is subtracted from the DRG medical insurance payment sum to obtain the profit and loss of the cost generated by each patient.

Further, the specific steps of calculating the DRG weight performance cost are as follows:

extracting disease weight scores in patient information, searching steps where DRG disease seeds are located according to weight step criteria, and multiplying the disease weight scores by criteria of corresponding steps to obtain weight performance.

Furthermore, the accounting department to which the disease species belongs is determined according to the discharge department id, and the total weight performance of the department is summarized to obtain the total weight performance of the department.

Further, configuring the data of the performance accounting module includes: weight ladder standard configuration, weight score configuration and profit and loss point value configuration.

Further, the medical quality examination system also comprises an examination module, wherein the examination module is used for medical quality examination of medical departments, nursing departments and quality control departments of hospitals _。

The second aspect of the present invention provides a DRG-based hospital performance management method, comprising the steps of:

patient information is acquired, and a DRG standard library is constructed;

considering medical conditions of hospitals, dividing disease weight grades according to the DRG weight scores and the score proportion of the hospitals, and formulating ladder standards based on the disease weight grades;

calculating performance cost by using the ladder standard and the patient payment information in the patient information;

and carrying out statistics and preservation on performance cost of all departments, and adjusting performance coefficient configuration according to the statistics result.

The one or more of the above technical solutions have the following beneficial effects:

the invention discloses a hospital performance management system and method based on DRG, which overcomes the management defect brought by the prior performance scheme management system based on balance accounting performance or simply taking workload (RBRVS) as a guide, and adopts a DRG performance calculation mode taking workload as a calculation reference to carry out performance management. And a scientific hospital performance management system is created by optimizing configuration of limited resources of a hospital and standardizing performance operation flows.

Additional aspects of the invention will be set forth in part in the description which follows and, in part, will be obvious from the description, or may be learned by practice of the invention.

Drawings

The accompanying drawings, which are included to provide a further understanding of the invention and are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and together with the description serve to explain the invention.

Fig. 1 is a block diagram of a DRG-based hospital performance management system in accordance with the present invention.

Detailed Description

It should be noted that the following detailed description is exemplary and is intended to provide further explanation of the invention. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.

It should be noted that, in the embodiments of the present invention, related data such as hospital patient information is related, and when the above embodiments of the present invention are applied to specific products or technologies, user permission or consent is required to be obtained, and the collection, use and processing of related data is required to comply with related laws and regulations and standards of related countries and regions.

It is noted that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of exemplary embodiments according to the present invention. As used herein, the singular is also intended to include the plural unless the context clearly indicates otherwise, and furthermore, it is to be understood that the terms "comprises" and/or "comprising" when used in this specification are taken to specify the presence of stated features, steps, operations, devices, components, and/or combinations thereof;

embodiment one:

an embodiment of the present invention provides a hospital performance management system based on DRG, as shown in fig. 1, including:

the medical information module is used for acquiring patient information and hospital configuration information; and (3) sorting patient information and hospital configuration information, and then respectively establishing and managing files.

In one embodiment, patient information is obtained from a monthly Hospital Information System (HIS) provided MEDICAL insurance statement patient information table, the patient information including a patient DRG CODE (drg_code), a DRG MEDICAL insurance payment TOTAL (drg_function_pay_total_period), an discharge WARD ID (outos_ward_id), an discharge department ID (outos_dept_id), and a MEDICAL FEE TOTAL (medical_fee_total_period); the hospital configuration information includes ward configuration information, department configuration information, and department point value tables.

The DRG module is used for establishing a DRG standard library and providing DRG grouping information; wherein, the DRG grouping information comprises DRG codes (DRG_ID), DRG NAMEs (DRG_NAME), DRG WEIGHTs (DRG_VALID_WEIGHT), DRG WEIGHT ladder STANDARDs (DRG_STEP_STANDARD) and surplus and deficit ladder STANDARDs (YKE _STEP_STANDARD).

In a specific embodiment, the DRG code, DRG name, DRG weight, etc. are derived from an existing DRG system. The DRG data is a piece of data of a patient, the system searches a corresponding accounting department according to a patient discharge department, and searches a section according to the weight of the data and the weight ladder standard. The hospital medical condition, namely the existing medical level of the hospital, strategic planning of the hospital and the like are considered, disease seed weight grades are divided according to the DRG weight scores and the score ratio of the hospital, and a weight step standard and a profit and loss step standard are formulated based on the disease seed weight grades. The configuration of the parameters can be implemented by a configuration module.

The performance accounting module is used for performing performance calculation according to the DRG grouping information in the DRG module and the patient information in the medical information module; the performance calculation comprises DRG operation performance fee calculation and DRG weight performance fee calculation.

In a specific embodiment, the DRG operation performance fee is divided into medical department DRG operation performance fee calculation and nursing department DRG operation performance fee calculation. And the performance accounting module extracts the disease weight scores in the patient information in the medical information module, and performs weight level matching and surplus and deficit level matching according to the weight level standards configured by the configuration module.

The specific steps of medical department DRG operation performance fee calculation are as follows:

determining a medical department according to the discharge department id, and searching a corresponding profit and loss point value of the medical department by using a department point value table; the department point value table is a coefficient table for computing DRG performance for the department, and is obtained by point value computation through department associated medical insurance settlement profit and loss conditions.

And multiplying the surplus and the deficit with the surplus and deficit point value of the corresponding ladder according to the surplus and deficit ladder standard to obtain the DRG operation performance fee of the medical department.

The specific steps of DRG operation performance fee calculation in nursing departments are as follows:

determining a nursing department according to the discharge department id, and searching a corresponding profit and loss point value of the nursing department by using a department point value table;

and multiplying the surplus and the deficit with the surplus and deficit point value of the corresponding ladder according to the surplus and deficit ladder standard to obtain DRG operation performance fee of the nursing department.

And searching the total amount of the DRG medical insurance payment in the patient information, and subtracting the total amount of the medical fee from the total amount of the DRG medical insurance payment to obtain the surplus and deficient amount of the cost generated by each patient.

The specific steps of DRG weight performance fee calculation are as follows:

and searching the ladder where the DRG disease is located according to the weight ladder standard, and multiplying the weight by the standard of the corresponding ladder to obtain the weight performance.

And determining the accounting department to which the disease species belongs according to the discharge department id, and summarizing all weight performance of the department to obtain the weight total performance of the department.

And the operation performance fees and the weight performance fees calculated by the performance accounting module are collected, form is generated and archived, and the operation performance fees and the weight performance fees can be used for subsequent assessment or standard formulation requirements.

And the configuration module is used for configuring the data of the DRG module.

In one embodiment, configuring the data of the performance accounting module includes: weight ladder standard configuration, weight score configuration and profit and loss point value configuration.

And the assessment module is used for medical quality assessment of medical departments of hospitals, nursing departments and quality control departments. The examination comprises a plurality of indexes such as the medicine proportion and the consumption proportion of the department. Specifically, the operation performance fee and the weight performance fee calculated in the performance accounting module are extracted, and an assessment report is made according to the assessment index.

In a specific embodiment, the configuration module adaptively adjusts and reformulates the weight ladder criteria, the weight scores, and the profit and loss point values based on the assessment criteria for each month.

It should be noted that, the performance management system of the hospital in this embodiment performs performance management by combining the calculation mode of DRG performance with workload, and performs calculation and arrangement by adopting the calculation mode of DRG performance on the basis of the original workload calculation.

Embodiment two:

the second embodiment of the invention provides a hospital performance management method based on DRG, which comprises the following steps:

patient information is acquired, and a DRG standard library is constructed;

considering medical conditions of hospitals, dividing disease weight grades according to the DRG weight scores and the score proportion of the hospitals, and formulating ladder standards based on the disease weight grades;

calculating performance cost by using the ladder standard and the patient payment information in the patient information;

and carrying out statistics and preservation on performance cost of all departments, and adjusting performance coefficient configuration according to the statistics result.

The steps involved in the second embodiment correspond to those of the first embodiment of the method, and the detailed description of the second embodiment can be found in the related description section of the first embodiment.

It will be appreciated by those skilled in the art that the modules or steps of the invention described above may be implemented by general-purpose computer means, alternatively they may be implemented by program code executable by computing means, whereby they may be stored in storage means for execution by computing means, or they may be made into individual integrated circuit modules separately, or a plurality of modules or steps in them may be made into a single integrated circuit module. The present invention is not limited to any specific combination of hardware and software.

While the foregoing description of the embodiments of the present invention has been presented in conjunction with the drawings, it should be understood that it is not intended to limit the scope of the invention, but rather, it is intended to cover all modifications or variations within the scope of the invention as defined by the claims of the present invention.

Claims (10)

1. A DRG-based hospital performance management system, comprising:

the DRG module is used for establishing a DRG standard library and providing DRG grouping information; the DRG grouping information comprises DRG codes, DRG names, DRG weights, DRG weight ladder standards and profit and loss ladder standards;

the performance accounting module is used for performing performance calculation according to the DRG grouping information in the DRG module and the patient information in the medical information module; the performance calculation comprises DRG operation performance fee calculation and DRG weight performance fee calculation;

and the configuration module is used for configuring the data of the DRG module.

2. The DRG-based hospital performance management system of claim 1, wherein the patient information includes patient DRG code, DRG medical insurance payment total, discharge ward id, discharge department id, disease seed weight, patient payment total, and DRG medical insurance reimbursement total; the hospital configuration information includes ward configuration information, department configuration information, and department point value tables.

3. The DRG-based hospital performance management system of claim 2, wherein the hospital medical level is considered, the disease category weight levels are divided according to hospital DRG weight scores and score duty ratios, and the weight step criteria and the profit step criteria are formulated based on the disease category weight levels.

4. The DRG-based hospital performance management system of claim 3, wherein the DRG operation performance fee calculation comprises the specific steps of:

determining a medical department according to the discharge department id, and searching a corresponding profit and loss point value of the medical department by using a department point value table;

and multiplying the surplus and the deficit with the surplus and deficit point value of the corresponding ladder according to the surplus and deficit ladder standard to obtain the DRG operation performance fee of the medical department.

5. The DRG-based hospital performance management system of claim 4, wherein the DRG medical insurance payment sum is looked up in the patient information, and the patient payment sum is subtracted from the DRG medical insurance payment sum to obtain the profit and loss of each patient generated cost.

6. The DRG-based hospital performance management system of claim 2, wherein the DRG weight performance fee calculation comprises the specific steps of:

extracting disease weight scores in patient information, searching steps where DRG disease seeds are located according to weight step criteria, and multiplying the disease weight scores by criteria of corresponding steps to obtain weight performance.

7. The DRG-based hospital performance management system of claim 6, wherein the accounting department to which the disease species belongs is determined based on the discharge department id, and the total weight performance of the departments is summarized to obtain the total weight performance of the departments.

8. The DRG-based hospital performance management system of claim 1, wherein configuring data of the performance accounting module includes: weight ladder standard configuration, weight score configuration and profit and loss point value configuration.

9. The DRG-based hospital performance management system of claim 1, further comprising an assessment module for medical quality assessment by a hospital medical department, a care department, a quality control department _。

10. The hospital performance management method based on the DRG is characterized by comprising the following steps of:

patient information is acquired, and a DRG standard library is constructed;

considering medical conditions of hospitals, dividing disease weight grades according to the DRG weight scores and the score proportion of the hospitals, and formulating ladder standards based on the disease weight grades;

calculating performance cost by using the ladder standard and the patient payment information in the patient information; and carrying out statistics and preservation on performance cost of all departments, and adjusting performance coefficient configuration according to the statistics result.