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題 名 | 建構健保手術醫令比對ICD處置碼知識庫於手術預審--以提升處置編碼效益=Construct Information System to Develop a Knowledge Database for Surgery Orders in Accordance with Surgical Related Procedure |
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作 者 | 陳麗淑; 蔣以仁; 楊騰芳; | 書刊名 | 病歷管理期刊 |
卷 期 | 6:2 2007.04[民96.04] |
頁 次 | 頁38-52 |
分類號 | 419.26 |
關鍵詞 | 疾病分類; 國際疾病分類第九版臨床修訂版; 診斷關係群; 病歷品質; Disease classification; International classification of disease; 9[90bb] edition; ICD-9-CM; Diagnostic related groups; DRGs; Medical record quality; |
語 文 | 中文(Chinese) |
中文摘要 | 近年醫療費用不斷上漲,醫療財務已入不敷出,在二代健保改革聲浪四起時,健保局預計於2008年推行DRGs支付制度,並以DRGs之權值點數換算為醫療償付金額。因此,疾病分類人員如何依據病歷記載,提升編碼品質的完整及準確,遂成為醫療償付之重要關鍵。 不正確的編碼品質無法有效反映醫療成本及醫療品質,進而無法合理分配醫療資源。因此,本研究期望建立健保手術醫令比對外科系疾病分類處置編碼知識庫,期能應用於手術醫令預審及DRGs編碼資訊系統,縮短處置編碼時間,並提升編碼之準確性與完整性。 經採回溯性手術預審後發現原始健保醫令比對ICD處置碼知識庫仍有疏漏處,與研究之醫學中心疾病分類專家確核後,新增健保醫令比對ICD處置碼118筆,另有32筆出院病人該醫學中心病歷室已完成疾病編碼,但並未登錄ICD處置碼而影響比對結果。建議未來持續進行並擴大健保醫令比對ICD處置知識庫,以增進ICD處置碼及申報醫令碼之正確性,並提升預審效益及疾病分類人員編審之一致性。 |
英文摘要 | Medical expenditure has increased rapidly in the recent years. The Bureau of National Health Insurance plans to implement a DRGs based reimbursement system in 2007 to cope with the second generation reform of National Health Insurance. Suppliers under this system would be reimbursed based on DRGs weighted utilization. How to improve coding quality and accuracy for disease classification based on patient records is thus an important element for this reimbursement system. Imprecise coding would not reflect actual medical cost and quality, and thus would lead to inefficient medical resource allocation. This research aims to use information system to develop a knowledge database for surgery orders in accordance with surgical related procedure. This would aid in pre-assessment for surgery orders and DRGs coding information system, and reduce time required fro coding and improving precision and accuracy. Comparing with the knowledge database, we found that there were still 118 surgery orders that could not match with ICD codes. There were 32 cases that could not match with ICD codes and thus affected the outcome for comparison, and this has already been established by the surgery pre-assessment. It is recommended that in order to increase the efficiency of pre-assessment and consistency of disease classification, matching medical orders and ICD code knowledge database should be continued, and the scope of comparison should be increased to improve accuracy. |
本系統中英文摘要資訊取自各篇刊載內容。