JP2002132936A - System for deciding drg number - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a data processing system, in which the disease name of a patient and diagnosis and treatment activities can be retrieved easily and a corresponding DRG number(diagnostic-related groups number) can be decided. SOLUTION: This data processing system consists of a process, in which a thesaurus dictionary is retrieved on the basis of an inputted keyword and a main disease name, disease complication and treatment/operation are respectively decided, a patient information input process for inputting patient information, and a process in which inference is performed by the decided main disease name, disease complication, treatment/operation, inputted patient information and rule stored in a rule base to decide a DRG number.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a data processing system used in a hospital, and more particularly to a system for determining a DRG number to be assigned to a patient from information such as a patient's disease name and operation name.

[0002]

2. Description of the Related Art In the current health insurance system, medical fees paid to a doctor or a medical institution are calculated in principle by a piece-wise payment method. In the piece-for-pay system, medical fees are paid for all examinations and treatments performed on patients. However, under such a system, medical care of so-called "test pickling" and "medicine pickling" in which excessive testing and medication are performed is likely to be caused, and there is a problem that medical costs soar.

[0003] Against this background, a new comprehensive payment system has been introduced as a means of calculating medical fees. In the comprehensive payment method, each patient is given a DRG (Diag) based on two things: (1) disease name and (2) medical practice.
Nosis RelatedGroup (disease-related group), and a DRG number is assigned.
Table 1 shows an example of classification by DRG.

[0004]

[Table 1]

According to Table 1, for example, a patient whose disease name is "brain tumor (no complication)" and whose medical treatment or the like is "no surgery, no chemotherapy and no radiotherapy" is a DRG number of "101" (diagnosis group). (Classification number). In this case, a point of 44,352 points is described in the rightmost column, and a medical treatment fee is paid based on this point. In other words, patients with brain tumors without complications who do not undergo surgery, chemotherapy, or radiation therapy, receive a uniform 44,352 points of medical treatment regardless of the presence or absence of other treatment and the length of hospital stay. Rewards are paid.

Further, if DRG numbers are assigned to individual patients, for example, it is possible to compare treatment costs and treatment periods required before discharge from patients having the same DRG number who are admitted to different hospitals. Become. That is,
A standard for comparing treatment methods and treatment costs between hospitals can be obtained, and management of each hospital can be improved. Furthermore, by standardizing the medical treatment for patients with the same DRG number, medical standardization can be achieved.

[0007] Thus, patients are classified by DRG,
Assigning a DRG number to individual patients has the benefits of reducing medical costs and improving hospital management, and is very beneficial for Japan, which is facing a serious aging society. In reality, no data processing system for assigning numbers has been developed.

[0008]

According to the present invention, it is possible to easily search for a disease name or a medical treatment that has been subdivided and which has a great variety of diseases, and that corresponds to an individual patient. It is an object of the present invention to provide a data processing system capable of quickly and accurately determining a disease name and a DRG number corresponding to a medical treatment.

[0009]

In order to achieve the above object, a DRG number determination system according to the present invention is a DRG number determination system for assigning a DRG number (diagnosis group classification number) to each patient. A main disease name search / determination step of searching a thesaurus dictionary based on the keyword of the inputted disease name and determining one main disease name;
A thesaurus dictionary is searched based on the input complication keywords, a complication search / decision step for determining one or more complications, and a thesaurus dictionary is searched based on the input treatment / operation keywords. A treatment / surgery search / decision step for deciding one or more treatments / surgery, a patient information inputting step for inputting patient information, and the determined main disease name, complications, treatment / surgery and inputted patient Make inferences with the information and the rules stored in the rule base,
This is a configuration including a DRG number inference / determination step of determining a DRG number.

[0010]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, a DRG number determination system according to the present invention will be described in detail with reference to the drawings. FIG. 1 is a block diagram showing the flow of the system of the present invention. The DRG number determination system 10 according to the present invention includes a main disease name search / determination step 20, a complication search / determination step 30, a treatment / surgery search / determination step 40, and a patient information input step 50.
And a DRG number inference / determination step 60.

The main disease name search / decision step 20 is a step of selecting one of the main disease names most suitable for the patient by searching with a keyword. There are several classification methods for disease names and they are not standardized among hospitals.
In order to determine the G number, the disease name must be based on ICD9 (International Classification of Diseases, 9th edition) or ICD10 (10th edition, same). In this process, when the operator inputs a keyword, the ICD 9 stored in the thesaurus dictionary
All disease names including a keyword are searched and extracted from a disease name file conforming to the ICD10. The operator selects and determines one of the main disease names most suitable for the patient. If the exact name of the main disease is known from the beginning, the name of the main disease can be directly input.

The complication search / determination step 30 is a step of selecting a complication of a patient by a search using a keyword. The complication is determined by repeating the main disease name search / determination step 20 again. In determining the DRG number, one main disease name is always required, but there may be no complication, or one or more complications. If the patient has no complications, this step is omitted.

The treatment / surgery search / determination step 40 is a step of selecting a treatment / surgery by a search using a keyword. For treatment and surgery, see ICD9CM (International Classification of Diseases 9
Version) or the name conforming to K-CODE, so the IC stored in the thesaurus dictionary
Search all treatments / surgeries including keywords from treatment / surgery files based on D9CM and K-CODE,
Select and determine an appropriate one from among them. Note that, like complications, treatment / surgery is not an essential item in DRG determination, so this step can be omitted in some cases.

FIG. 2 shows a configuration diagram of an example of a search system used in each of the above search / determination steps. The full-text search system 700 used for the search includes a thesaurus dictionary 72, an indexer 704, an index 706, a search engine 70
8. The thesaurus dictionary 72 contains an IC
I which is a file in which all disease names conforming to D are described
A CD master and a K-CODE master, which is a file in which all procedures and operations by the K-CODE are described, are stored. Although it is possible to directly perform a skewer search using a keyword on the thesaurus dictionary 72,
There is a problem that the processing speed is reduced. Therefore, the indexer 704 creates the index 706 of the thesaurus dictionary 72 in advance. Thus, when the operator inputs a keyword in each search / decision step, the search engine 708 searches the index 706, so that the processing speed can be greatly improved.

In the patient information input step 50, patient information such as patient age and emergency hospitalization, insulin injection, surgery, chemotherapy, radiation therapy, immunotherapy, ethanol local injection, liver malignant tumor microwave coagulation, artificial kidney, The presence / absence of plasma exchange therapy and peritoneal perfusion, the degree of nursing, the degree of disability, the severity, etc. are shown. As described above, the DRG number is determined by two factors: (1) disease name (main disease name, complication) and (2) medical treatment (treatment / surgery). In some cases, the presence or absence of surgery may be asked. In such a case, it is possible to skip the treatment / surgery search / determination step 40 and proceed to the patient information input step 50 to input necessary information. In other words, the patient information input step 50 is a step that assists the treatment / operation search / decision step 40.

In the DRG number inference / determination step 60,
This is a step of determining a DRG number by forward inference based on the data obtained in each of the above steps. The inference rule is determined for each main disease name and stored in the rule base, so that when the main disease name is determined, the corresponding rule is automatically determined. Complications, treatment / surgery, and other patient information are collated with the condition part of the rule to make an inference, and a DRG number is derived as a conclusion part.

Next, an embodiment of the present invention will be specifically described with reference to the configuration diagram shown in FIG. First, in order to determine the main disease name, the disease name 74 is input to the DRG number determination system 10. For input, a personal computer or the like having a display means (not shown) such as a display and an input means (not shown) such as a keyboard and a mouse is used, and an input is made at a predetermined location displayed on the display means by the input means. Do. If the exact disease name is known, enter it. If not, enter the keyword. The full-text search function 70 searches the thesaurus dictionary 72 based on the input keyword. Disease names conforming to ICD9 and ICD10 are stored as data in the thesaurus dictionary 72, and all disease names including keywords are retrieved and displayed on the display means.
The operator selects an optimal one from the displayed list of disease names and makes a decision via the input means. In addition, in the search, head match, tail match, AND by multiple keywords
It is also possible to provide functions such as search, OR search, and input of a search expression.

In the case of a patient having a complication, a keyword of the complication is inputted to the disease name 74 in the same manner, and the complication is determined. In the case of a patient having multiple complications, all the complications are determined by repeating the above operation.

The input of the treatment / surgery name 76 is the same as the input of the disease name 74. By inputting a keyword, the full-text search function 70 searches the thesaurus dictionary 72. Thesaurus dictionary 72 contains ICD9CM and K-CO
Since the treatment / surgery name based on DE is stored, a list of treatment / surgery names including the keyword is searched and displayed. The operator selects a suitable one from among them and makes a decision through the input means.

Since a code number is given to each disease name and treatment / operation name, if the disease name and treatment / operation name are determined, the disease name code and the treatment / operation name code are automatically determined. This step is shown in FIG. In the subsequent inference process, processing is performed using these code numbers.

The obtained disease name code and treatment / operation name code are sent to the inference function 80. In addition, the severity 86 expressed step by step with patient information 84 such as the presence or absence of surgery and numerical values,
After being input through the input means and converted into a code number, it is sent to the inference function 80. The inference function 80 includes the obtained main disease name code, complication code, treatment / operation name code,
Inference is performed using the patient information code, the severity code, and the rules stored in the rule base 82 to determine the DRG number. The rule base 82 stores rules determined for each code number of the main disease name. Inference function 80
Thus, the corresponding rule is first extracted from the rule base 82 according to the code number of the main disease name. Subsequently, the complication code, the treatment / surgery name code, the patient information code, and the severity code are collated with the condition part of the extracted rule, and the DRG number is determined as the conclusion part. The determined DRG number is displayed to the operator by the display means. The rule used for determining the DRG number can be displayed on the display means, and the operator can refer to the process of determining the DRG number.

[0022]

According to the DRG number determination system of the present invention described in detail above, a disease name and a treatment / operation name can be easily searched and determined only by inputting a keyword, and the corresponding DRG number can be determined. Can be checked quickly and accurately.

[Brief description of the drawings]

FIG. 1 is a block diagram of a DRG number determination system according to the present invention.

FIG. 2 is a configuration diagram of a full-text search system used in the present invention.

FIG. 3 is a configuration diagram of a DRG number determination system according to the present invention.

[Explanation of symbols]

 Reference Signs List 10 DRG number determination system 20 Main disease name search / determination process 30 Complication search / determination process 40 Treatment / surgery search / determination process 50 Patient information input process 60 DRG number inference / determination process 70 Full-text search function 72 Thesaurus dictionary 74 Disease name 76 Treatment・ Surgery name 78 Coding 80 Inference function 82 Rule base 84 Patient information 86 Severity 704 Indexer 706 Index 708 Search engine

Claims (1)

[Claims] 1. A DRG number determination system for assigning a DRG number (diagnosis group classification number) to each patient, wherein a DRG number is searched based on a keyword of an input disease name, and one main disease name is searched. A main disease name search / decision process to be decided, a thesaurus dictionary is searched based on the inputted complication keywords, and a complication search / decision process to decide one or more complications, and the inputted treatment / surgery A treatment / surgery search / decision step of retrieving a thesaurus dictionary based on the keywords of and determining one or more treatments / surgeries; a patient information input step of entering patient information; DRG number inference / determination for determining the DRG number by inferring based on the disease, treatment / surgery and the input patient information and the rules stored in the rule base DRG number determining system, wherein the extent, that it consists