LU503510B1 - Medical expenses management system based on drg - Google Patents
Medical expenses management system based on drg Download PDFInfo
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- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
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Abstract
The invention relates to a medical expenses management system based on DRG, which comprises a database module, a data acquisition module, a medical record upload analysis module, a feedback module and a result output module. The database module, the data acquisition module and the medical record upload analysis module are connected in sequence, and the feedback module and the result output module are connected with the medical record upload analysis module respectively. The invention solves the problems of low operation efficiency and low accuracy caused by manual operation in the past.
Description
DESCRIPTION LU503510
MEDICAL EXPENSES MANAGEMENT SYSTEM BASED ON DRG
The invention relates to the technical field of intelligent medical information processing, and in particular to a medical expenses management system based on
DRG.
Diagnosis Related Groups (DRG) is an important tool for measuring the quality and efficiency of medical services and making medical insurance payments. In essence,
DRG is a case mix classification scheme, that is, a system that divides patients into several diagnosis groups for management according to factors such as age, disease diagnosis, comorbidities, complications, treatment methods, severity and outcome of diseases and resource consumption.
The existing medical expenses management system usually determines the overall expense target for DRG grouping, but lacks the control means for each item expense in the specific diagnosis and treatment process. Because the patients’ actual situation, disease situation, severity and complications are different, the treatment plans and expenses are also different, making it difficult to control the expenses. Before the implementation of DRG, according to the actual cost of hospitalization, the amount of the reimbursable part of medical insurance is calculated and paid to the hospital. After the implementation of DRG, the payment amount of medical insurance does not change with the actual hospitalization expenses, but is settled according to the payment standard of the DRG group. The hospital can predict the compensation standard of medical insurance payment of the DRG group, and consciously implement the diagnosis and treatment according to the most effective and least resource-consuming scheme. In every medical business activity, the medical quality and cost are considered.
DRG, whose core function is performance evaluation and cost management of inpatient medical services, has been gradually popularized and applied in medical and 508540 health care fields in recent years. Under this background, how to construct DRG medical expenses management system in hospital, give full play to DRG management function, and improve hospital's high-quality development and new efficiency is an important task at present and in the future.
The purpose of this invention is to provide a medical expenses management system based on DRG, which can compare and analyze medical expenses and costs in the process of medical diagnosis, and provide a basis for medical staff to make decisions.
To achieve the above purpose, the present invention provides the following solutions:
A medical expenses management system based on DRG includes: a database module: used for storing the medical expenses management database; a data acquisition module: used for acquiring patient information and medical information; a medical record upload analysis module: used for users to query the summary of all medical insurance credit card fees, quantities and uploaded medical records in the corresponding hospitals within a certain period of time; a feedback module: used for classifying, summarizing, dynamically monitoring and feeding back various DRG data and the analysis results, and generating a grouped medical financial information summary report according to DRG grouping results, DRG group weights and medical financial classification summary information; a result output module: used for transmitting the grouped medical financial information summary report to the hospital information system for display; where, the database module, the data acquisition module and the medical record upload analysis module are connected in sequence, and the feedback module and the result output module are connected with the medical record upload analysis module respectively.
Preferably, the medical expenses management database includes related rules of medical expenses management and DRG grouping scheme, where the related rules Pf503510 medical expenses management include: related rules of medical insurance/welfare, economic control, applicability, taboo, allergy, time, development method/usage method, dosage, adverse reactions preparation/protection measures and administration management.
Preferably, the patient information includes gender, age, weight and home address, and the medical information includes diagnosis results, operation types and treatment characteristics.
Preferably, the medical record upload analysis module comprises: a medical record home page collection unit: used to query the information of the corresponding patient's credit card settlement expenses and the related situation of medical record uploading, and check the expenses before fund settlement; a matching details query unit: used for users to query the summary of all medical insurance credit card fees, quantity and uploaded medical records of the corresponding hospitals in a period of time, and to view the corresponding fee details and medical record details.
Preferably, the medical record upload analysis module displays the medical record situation through the medical record analysis histogram and the medical record detail table.
Preferably, the feedback module comprises: a storage unit: used for storing the DRG grouping result, the weight of the corresponding DRG group and all medical financial classification summary information; a quantitative evaluation unit: used for comparing, analyzing, evaluating, dynamically monitoring and feeding back various DRG data according to the generated grouped medical financial information summary report.
Preferably, the quantitative evaluation unit constructs a visual hierarchical analysis from the dimensions of hospital, department, patient group, medical group, doctor and case, and analyzes the cost structure in the process of medical behavior through step-by-step screening and step-by-step positioning.
Preferably, the result output module is used to transmit the grouped medical financial information summary chart to the hospital information system to show to the medical staff for their decision-making; the display form of the summary chart includes 503510 sorting by different indicators or longitudinal trend comparison of indicators of the same project.
The invention has the beneficial effects as follows:
The medical expenses management system based on DRG provided by the invention can accurately control medical expenses, reasonably allocate medical resources, standardize diagnosis and treatment behaviors, avoid over-treatment, and reduce the economic burden of patients; it makes the use of medical insurance expenses more reasonable, and solves the problems existed in the past of low operating efficiency and low accuracy of manual operation.
In order to more clearly explain the embodiments of the present invention or the technical solutions in the prior art, the following will briefly introduce the drawing that need to be used in the embodiments. Obviously, the drawing in the following description is only some embodiments of the present invention. For those of ordinary skill in the art, other drawings can be obtained according to the drawing without any creative labor.
FIG. 1 is a structural diagram of a medical expenses management system based on
DRG according to an embodiment of the present invention.
Technical solutions in embodiments of the present invention will be described clearly and completely below with reference to the accompanying drawings in which embodiments of the present invention are shown. it is obvious that the described embodiments are only a part of embodiments of the present invention, but not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by a person of ordinary skill in the art without creative work are within the scope of the present invention.
In order to make the above objects, features and advantages of the present invention more obvious and understandable, the present invention will be explained (N503510 further detail below with reference to the drawings and detailed description.
Referring to FIG. 1, this embodiment provides a medical expenses management system based on DRG, including: a database module: used for storing the medical expenses management database; a data acquisition module: used for acquiring patient information and medical information: a medical record upload analysis module: used for users to query the summary of all medical insurance credit card fees, quantities and uploaded medical records in the corresponding hospitals within a certain period of time; a feedback module: used for classifying, summarizing, dynamically monitoring and feeding back various DRG data and the analysis results, and generating a grouped medical financial information summary report according to DRG grouping results, DRG group weights and medical financial classification summary information; a result output module: used for transmitting the grouped medical financial information summary report to the hospital information system for display; where, the database module, the data acquisition module and the medical record upload analysis module are connected in sequence, and the feedback module and the result output module are connected with the medical record upload analysis module respectively.
To further optimize the scheme, the medical expenses management database includes related rules of medical expenses management and DRG grouping scheme, where the related rules of medical expenses management include: related rules of medical insurance/welfare, economic control, applicability, taboo, allergy, time, development method/usage method, dosage, adverse reactions preparation/protection measures and administration management.
In this embodiment, DRG groups are grouped according to CHS-DRG grouping scheme (version 1.1), including 628 disease diagnosis related groups, including 235 surgical operation groups, 34 non-operating room operation groups and 359 medical diagnosis groups. 4678 MCC are rebuilt.
To further optimize the scheme, the patient information includes gender, age, weight and home address, and the medical information includes diagnosis results, operatiqn 593540 types and treatment characteristics.
The medical record upload analysis module comprises: a medical record home page collection unit: used to query the information of the corresponding patient's credit card settlement expenses and the related situation of medical record uploading, and check the expenses before fund settlement; function description: querying, viewing and exporting query results; query criteria: settlement time (month), overall planning category, institution information and institution level.
Operation instructions: clicking the [medical record home page matching query (summary)] button in the navigation bar to enter the query page, entering the query criteria, and clicking the [query] button to display the query results; clicking the page collapse button to expand/hide the advanced medical record query; clicking the “details” button to open the expense details view interface to view the detailed expense information corresponding to the expense; clicking the View Medical Record button on the interface to continue to open the View Medical Record Details interface to view the details of medical records.
A matching details query unit: used for users to query the summary of all medical insurance credit card fees, quantity and uploaded medical records of the corresponding hospitals in a period of time, and to view the corresponding fee details and medical record details.
Function description: querying, viewing and exporting query results;
Query criteria: settlement time, overall planning category, institution information, institution level, admission time, discharge time, medical record uploading sign, medical treatment sign in different places, ID card number and transaction type; clicking the [medical record home page matching query (details)] button in the navigation bar, entering the query page, entering the query criteria, and clicking the [query] button to display the query results; clicking the page collapse button to expand/hide the advanced medical record query; clicking the operation "details" button to open the medical record viewing interface and view the detailed medical record information corresponding to the expenses.
To further optimize the scheme, the medical record upload analysis module displays 503510 the medical record situation through the medical record analysis histogram and the medical record detail table.
The feedback module comprises: a storage unit: used for storing the DRG grouping result, the weight of the corresponding DRG group and all medical financial classification summary information; the storage unit stores relevant information through the DRG analysis unit, where the DRG analysis unit includes the DRG index information for dynamically querying the
DIP index information of departments, diagnosis and treatment groups or the whole hospital according to the time period, the DRG index information for dynamically querying the DIP index information of departments, diagnosis and treatment groups or the whole hospital according to the time period, and the related index information for dynamically querying the DIP relative DRG of a disease in departments, diagnosis and treatment groups or the whole hospital according to the time period, it is used to dynamically query the related index information of DRG relative to DIP of a certain disease in the department, diagnosis and treatment group or the whole hospital according to the time period, through independent selection and setting related medical insurance index parameters, and can view the detailed index information of all or some diseases according to the set medical insurance index parameters.
When in use: through the collection of DIP indicators of departments and groups, the DIP indicators of different diseases can be inquired according to the whole hospital, departments and diagnosis and treatment groups, as well as the related information of the department, disease code, fee category, disease classification, deviation mark, score,
CMI, inspection proportion, examination proportion, average cost, western medicine proportion and material proportion of patients admitted to hospital.
Through the collection of DRG indicators of departments and groups, checking the information of DRG related indicators, including date, department, DRG group, DRG group name, group case number and risk group; in the process of using, viewing the detailed information of the DRG group of a certain disease by double-clicking it, including the name and code of diagnosis, the name and code of operation, the discharge department and the proportion of inspection.
Through the DIP/DRG cross reference of the disease group, querying the related 503510 index information of DIP of the disease group relative to DRG of the disease group, including the index information of DIP of the disease group and the DRG index information of the corresponding disease group. For example, the disease type Z54.0: n (y), double-clicking the disease type to view the relationship information corresponding to the DIP/DRG of the department group.
Through the DRG/DIP cross reference of the disease group, querying the related index information of DRG of the disease group relative to DIP of the disease group, including the index information of DRG of the disease group and the index information of
DIP of the disease group corresponding to the department group DRG.
A quantitative evaluation unit: used for comparing, analyzing, evaluating, dynamically monitoring and feeding back various DRG data according to the generated grouped medical financial information summary report.
Quantitative evaluation principles include:
Quantitative evaluation principle: used to reflect the comprehensive ability of hospitals, departments and medical groups in terms of disease diagnosis and treatment ability, operational efficiency, resource consumption, etc.
Emphasis on CMI value principle: the CMI value of departments is the biggest weight in the scoring structure, which is used to reflect the emphasis on the diagnosis and treatment ability of departments with difficult diseases.
Per capita contribution principle: the number of people refers to the total number of people employed by the department. Per capita contribution represents the operational efficiency of a discipline. Under the same business volume, the larger the number of people, the higher the staff cost, and the lower the operational efficiency of the discipline.
Principle of reducing resource consumption: encouraging the discipline to continuously improve the control of medical expenses and shorten the average length of stay through time index and expense index.
To further optimize the scheme, the quantitative evaluation unit constructs a visual hierarchical analysis from the dimensions of hospital, department, patient group, medical group, doctor and case, and analyzes the cost structure in the process of medical behavior through step-by-step screening and step-by-step positioning.
Medical department and medical record statistics office are responsible for regulary,503510 analyzing and feeding back DRG-related data. Through the summary, comparison, analysis, evaluation, dynamic monitoring and feedback of various DRG data, the guiding opinions on improving disease structure and DRG performance index are put forward to clinical departments. The semi-annual work briefing and annual evaluation report of
DRG are prepared, including CMI ranking, distribution of key diseases, distribution of key operations, CMI comparison chart, etc, for analysis and decision-making by the hospital department.
Through the training of internal and external experts, the DRG management thinking of clinical departments is cultivated, and the operation skills of medical record information, major diagnosis and major surgery are improved. The work objectives are determined. With patient as the center, the balance of quality and cost achieves; the diagnosis and treatment behavior in combination with clinical pathway is standardized, the connotation of medical value is enhanced, and the rational and legal use of medical insurance fund is ensured; the concept and method of digital medical care are implemented, thus playing a monitoring role and assisting in decision-making.
To further optimize the scheme, the result output module is used to transmit the grouped medical financial information summary chart to the hospital information system to show to the medical staff for their decision-making; The display form of the summary chart includes sorting by different indicators or longitudinal trend comparison of indicators of the same project.
The workflow of this system includes: establishing medical expense management database. The medical expense management database includes the relevant rules of medical expense management, specifically including the rules and data of analysis / application / use of various items related to medical expense management, etc. It may also include interrelation / mutual influence / mutual transformation / rules / calculation methods among various / groups various element attributes.
Obtaining patient information, disease information and medical information.
Patient information includes: basic patient information, genetic related information, family health related information such as family history, medical history, allergy history,
regional epidemic history, medication history, operation history, medical device USE 03510 history, study situation, work situation, exercise situation, family situation, living environment, hobbies, compliance, tolerance and medical insurance.
Grouping DRG: patients are divided into DRG groups according to the criteria of
DRG grouping. In the present invention, the medical expense management method is mainly based on DRG/DIP to manage medical expenses, that is, according to the age of patients, disease diagnosis, complications, treatment methods, severity and outcome of diseases, resource consumption and other factors, cases are divided into groups, and then the specific goal of expense management is determined by grouping.
Decomposing the treatment plan, comprehensively analyzing the rationality and necessity of each sub-project, and giving the analysis results of the cost control of the treatment plan.
The medical expenses management system based on DRG provided by the invention can accurately control medical expenses, reasonably allocate medical resources, standardize diagnosis and treatment behaviors, avoid over-treatment, and reduce the economic burden of patients; it makes the use of medical insurance expenses more reasonable, and solves the problems existed in the past of low operating efficiency and low accuracy of manual operation.
The above-mentioned embodiments only describe the preferred mode of the invention, but do not limit the scope of the invention. On the premise of not departing from the design spirit of the invention, all kinds of modifications and improvements made by ordinary technicians in the field to the technical scheme of the invention shall fall within the scope of protection determined by the claims of the invention.
Claims (8)
1. A medical expenses management system based on DRG, characterized by comprising: a database module: used for storing the medical expenses management database; a data acquisition module: used for acquiring patient information and medical information: a medical record upload analysis module: used for users to query the summary of all medical insurance credit card fees, quantities and uploaded medical records in the corresponding hospitals within a certain period of time; a feedback module: used for classifying, summarizing, dynamically monitoring and feeding back various DRG data and the analysis results, and generating a grouped medical financial information summary report according to DRG grouping results, DRG group weights and medical financial classification summary information; a result output module: used for transmitting the grouped medical financial information summary report to the hospital information system for display; where, the database module, the data acquisition module and the medical record upload analysis module are connected in sequence, and the feedback module and the result output module are connected with the medical record upload analysis module respectively.
2. The medical expenses management system based on DRG according to claim 1, characterized in that the medical expenses management database includes related rules of medical expenses management and DRG grouping scheme, where the related rules of medical expenses management include: related rules of medical insurance/welfare, economic control, applicability, taboo, allergy, time, development method/usage method, dosage, adverse reactions preparation/protection measures and administration management.
3. The medical expenses management system based on DRG according to claim [503510 characterized in that the patient information includes gender, age, weight and home address, and the medical information includes diagnosis results, operation types and treatment characteristics.
4. The medical expenses management system based on DRG according to claim 1, characterized in that the medical record upload analysis module comprises: a medical record home page collection unit: used to query the information of the corresponding patient's credit card settlement expenses and the related situation of medical record uploading, and check the expenses before fund settlement; a matching details query unit: used for users to query the summary of all medical insurance credit card fees, quantity and uploaded medical records of the corresponding hospitals in a period of time, and to view the corresponding fee details and medical record details.
5. The medical expenses management system based on DRG according to claim 4, characterized in that the medical record upload analysis module displays the medical record situation through the medical record analysis histogram and the medical record detail table.
6. The medical expenses management system based on DRG according to claim 1, characterized in that the feedback module comprises: a storage unit: used for storing the DRG grouping result, the weight of the corresponding DRG group and all medical financial classification summary information; a quantitative evaluation unit: used for comparing, analyzing, evaluating, dynamically monitoring and feeding back various DRG data according to the generated grouped medical financial information summary report.
7. The medical expenses management system based on DRG according to claim 6, characterized in that the quantitative evaluation unit constructs a visual hierarchical analysis from the dimensions of hospital, department, patient group, medical group,
doctor and case, and analyzes the cost structure in the process of medical behavior 503510 through step-by-step screening and step-by-step positioning.
8. The medical expenses management system based on DRG according to claim 1, characterized in that the result output module is used to transmit the grouped medical financial information summary chart to the hospital information system to show to the medical staff for their decision-making; the display form of the summary chart includes sorting by different indicators or longitudinal trend comparison of indicators of the same project.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| LU503510A LU503510B1 (en) | 2023-02-17 | 2023-02-17 | Medical expenses management system based on drg |
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| Application Number | Priority Date | Filing Date | Title |
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| LU503510A LU503510B1 (en) | 2023-02-17 | 2023-02-17 | Medical expenses management system based on drg |
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| LU503510B1 true LU503510B1 (en) | 2023-08-17 |
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