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題名 | 疾病分類編碼與診斷關係群(DRGs)--美國之經驗=Coding and DRGs--The Lesson of the United State |
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作者 | 溫信財; | 書刊名 | 病歷管理期刊 |
卷期 | 5:1 民94.10 |
頁次 | 頁46-55 |
分類號 | 419.26 |
關鍵詞 | 疾病分類編碼; 診斷關係群; 正確性審查; ICD-coding; Diagnosis related groups; DRGs; Accuracy review; |
語文 | 中文(Chinese) |
中文摘要 | 美國實施診斷關係群(DRGs)巳有二十多年,該支付制度能有效控制醫療費用,且死亡率及再住院率等醫療品質指標並未惡化。而美國實施DRGs的經驗,特別是其與疾病分類編碼的關係,值得我們參考和學習。 為確保DRGs分派與疾病分類編碼之正確性,美國聯邦政府之「老人及貧民醫療服務中心 (CMS)」,(原名為「健康財務署」, Health Care Financial Administration, HCFA)及「總稽核辦公室」(Office of Inspector General, OIG)委託「品質促進組織 (Quality Improvement Organization, QIOs)」,(原名為「同儕審查組織」(Peer Review Organization, PRO),利用「國家臨床資料摘錄中心」(National Clinical Data Abstraction Centers, CDAC)及MEDPAR(Medicare Provider Analysis and Review)進行資料庫分析,在不同階段執行「預防支付錯誤專案」(Payment Error Prevention Program, PEPP),評估支付型態專案(Program for Evaluating Payment Patterns Electronic Report, PEPPER)及「醫院支付監督專案(Hospital Payment Monitoring Program, HPMP)」等稽核及監督計畫。 DRGs的實施對美國醫院之病歷管理作業產生顯著影響,住院病歷完成時效因此加強,病歷室呈報上級主管的對象因而改變,醫院更加重視病歷管理及疾病分類專業證照,並制訂疾病分類編碼指引(Coding Guidelines)及疾病分類編碼倫理規範(Standards for Ethical Coding),以配合醫療保險審查專案的要求。若國內健保局近期欲實施住院病例組合,各級醫院可成立DRG委員會,及評估病歷室能否快速反應此一新制度因應之。 |
英文摘要 | Diagnosis Related Groups (DRGs) were implemented in US over twenty years ago. This payment system controlled medical cost effectively while maintaining certain indicators of quality of care such as steady mortality and readmission rates. The lessons of US's DRGs are worthy for Taiwan to learn, especially the relationship between DRG assignment and ICD-9-CM coding. In order to verify the accuracy of DRG assignment and ICD-9-CM coding, The Centers for Medicare and Medicaid Service (CMS) (original name is Health Care Finance Administration, HCFA) and The Office of Inspector General (OIG) of the Department of Health and Human Services delegated Quality Improvement Organizations, (QIOs) (original name is Peer Review Organization, PRO) to analyze the National Clinical Data Abstraction Centers (CDAC) and Medicare Provider Analysis and Review (MEDPAR) databases. Many projects, such as the Payment Error Prevention Program (PEPP), Program for Evaluating Payment Patterns Electronic Report (PEPPER) and Hospital Payment Monitoring Program (HPMP) were implemented under different stages. The impact of DRGs was significant for US medical record management. The timeliness of record completion was faster than before. The superior changed to whom Medical Record Directors reported. Official coding guidelines and standards for ethical coding were established to fit the requirement of medical review. If Taiwan would like to implement DRGs in the near future, the suggestions for hospitals are to establish a DRG Committee and perform assessment of readiness of Medical Records Department and health information systems. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。