WO2020082785A1 - 基于数据处理的用药处方风险控制方法及装置 - Google Patents
基于数据处理的用药处方风险控制方法及装置 Download PDFInfo
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- WO2020082785A1 WO2020082785A1 PCT/CN2019/094996 CN2019094996W WO2020082785A1 WO 2020082785 A1 WO2020082785 A1 WO 2020082785A1 CN 2019094996 W CN2019094996 W CN 2019094996W WO 2020082785 A1 WO2020082785 A1 WO 2020082785A1
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
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- the present application relates to the field of medical technology, and in particular to a method and device for controlling the risk of medication prescriptions based on data processing.
- Various medication monitoring mechanisms are used to monitor medication for various medical units, including but not limited to medical units (or representatives of medical units) such as various hospitals, departments of various hospitals, various clinics, and even various physicians.
- the evaluation of the medication standard of each medical unit mainly adopts the sub-average prescription standard, that is, the average cost of prescriptions calculated each time (abbreviated as the sub-average prescription cost) is used as the evaluation standard of each medical unit.
- the evaluation criteria for the above-mentioned average prescription cost are calculated by dividing the total prescription by the number of prescriptions.
- the use of sub-average prescription cost as the evaluation standard of each medical unit has led each medical unit to be evaluated in order to avoid large prescriptions.
- the number of prescription days is reduced to reduce the average prescription cost, or a single prescription is broken down by breaking down the prescription.
- the embodiments of the present application provide a data prescription-based drug prescription risk control method and device.
- the operation is simple, which can improve the accuracy of medical unit drug monitoring, enhance the reliability of medical unit drug monitoring, and improve the effectiveness of medical resources.
- the utilization rate is more applicable.
- an embodiment of the present application provides a data prescription-based drug prescription risk control method, which includes:
- the above-mentioned daily average drug cost and the above-mentioned average daily drug cost threshold corresponding to the medical unit to be monitored determine whether the medication of the medical unit to be monitored exceeds the standard
- the drug cost of the above-mentioned medical unit to be monitored will be controlled based on the daily average drug cost.
- an embodiment of the present application provides a data prescription-based drug prescription risk control device.
- the drug monitoring device includes:
- the data acquisition unit is used to acquire the medication prescription of the medical unit to be monitored
- a medicine information processing unit configured to obtain the medicine information included in the medicine prescription obtained by the data obtaining unit, and determine the average daily medicine cost of the medical unit to be monitored according to the medicine information;
- the medication monitoring unit is used to determine whether the medication used by the medical unit to be monitored exceeds the standard according to the daily average drug cost determined by the drug information processing unit and the daily average drug cost threshold corresponding to the medical unit to be monitored;
- the drug risk control unit is used to prescribe the drug cost of the medical unit to be monitored based on the daily average drug cost determined by the drug information processing unit when the drug monitoring unit determines that the drug of the medical unit to be monitored exceeds the standard control.
- an embodiment of the present application provides a terminal device.
- the terminal device includes a processor and a memory, and the processor and the memory are connected to each other.
- the memory is used to store a computer program that supports the terminal device to execute the method provided in the first aspect and / or any possible implementation manner of the first aspect
- the computer program includes program instructions
- the processor is configured to call the foregoing Program instructions to execute the method provided in the first aspect and / or any possible implementation manner of the first aspect.
- an embodiment of the present application provides a computer-readable storage medium storing a computer program, the computer program including program instructions, which when executed by a processor causes the processor to execute The method provided in the foregoing first aspect and / or any possible implementation manner of the first aspect.
- the operation of monitoring the medication use of each medical unit is simple, which can improve the accuracy of the medication monitoring of the medical unit, improve the reliability of the medication monitoring of the medical unit, and increase the effective utilization of medical resources. More applicable.
- FIG. 1 is a schematic flow chart of a method for controlling risk of medication prescriptions based on data processing provided by an embodiment of the present application;
- FIG. 2 is another schematic flowchart of a data prescription-based drug prescription risk control method provided by an embodiment of the present application
- FIG. 3 is a schematic structural diagram of an embodiment of a medication prescription risk control device based on data processing provided by an embodiment of the present application;
- FIG. 4 is a schematic structural diagram of an embodiment of a terminal device provided by an embodiment of the present application.
- the embodiments of the present application provide a method for controlling the risk of medication prescriptions based on data processing, which can be based on the days of various hospitals, departments of various hospitals, various clinics and even various medical units (or representatives (or teams) of medical units) of various hospitals Evaluate the average drug cost of each medical unit (including hospitals, departments, clinics or physicians) whether the drug exceeds the standard (or unreasonable), and can publicize the daily average drug cost of the medical unit's prescription based on the drug use of the medical unit , And / or refusal to control the risk of excessive drug costs for prescription drugs such as reimbursement of drug costs corresponding to daily average drug costs, in order to avoid wasting medical resources.
- the assessment dimensions represented by the representatives of the above-mentioned hospitals, departments of various hospitals, clinics, and even doctors or other medical units or medical units will be described using the evaluation dimension of the medical unit as an example, and will not be described below.
- the medication prescriptions provided in the embodiments of the present application may include prescriptions issued by various doctors of various medical units for the symptoms of various patients, or referred to as prescriptions prescribed by various physicians for the symptoms of various patients, or prescription papers, etc., in There are no restrictions.
- the prescription will be described as an example below.
- the prescriptions issued by various doctors in various medical units may include but are not limited to the time of prescription issuance, prescription number, department number, patient personal information, drug details and physician signature, which can be determined according to the actual application scenario. There are no restrictions.
- each prescription will contain the details of the medicine issued by the medical unit, including but It is not limited to the name of the drug, the amount of the drug, the method of using the drug, and the number of days the drug is used. Therefore, whether it is a large prescription or a small prescription or other, it is inseparable from the drug details. Therefore, based on the average daily drug cost of each medical unit, the evaluation of the medical standard of each medical unit can be achieved to monitor the medical use of each medical unit. The operation is simple and can cover each prescription of the medical unit better and more comprehensively. Of medication monitoring.
- the drug monitoring of each medical unit is more accurate and in place, which can improve the accuracy of the drug monitoring of each medical unit, and thus can improve the medical condition based on the medical unit of each medical unit.
- the reliability of the risk control of over-the-counter drug prescriptions for prescriptions such as public notification of daily average drug costs exceeding the standard, and / or rejection of drug cost reimbursements corresponding to the daily average drug costs exceeding the standard, can improve the controllability of the prescription of the medical unit, Therefore, the effective utilization rate of medical resources can be improved, and the applicability is higher.
- the medical unit's drug usage can be monitored daily, and then the daily average medical cost of the medical unit can be settled based on the daily
- the average drug cost monitors the use of drugs by medical institutions.
- a comprehensive evaluation of the medication use of the medical unit based on the cumulative multi-day medication monitoring situation such as one week, one month, and one quarter Or one year, etc., which can be determined according to the actual application scenario, without limitation.
- the drug prescription risk control method based on data processing can be implemented by terminal devices associated with drug monitoring units such as the Drug Administration, the Health Commission, the Health and Health Commission, and medical claim units, for example, the above drug monitoring units are used for Clients and / or human-computer interaction devices that monitor medication in various medical units are not limited here.
- drug monitoring units such as the Drug Administration, the Health Commission, the Health and Health Commission, and medical claim units
- the above drug monitoring units are used for Clients and / or human-computer interaction devices that monitor medication in various medical units are not limited here.
- the terminal device will be taken as an example for description below.
- FIG. 1 is a schematic flowchart of a data prescription-based drug prescription risk control method provided by an embodiment of the present application.
- the drug prescription risk control method based on data processing provided by the embodiments of the present application can be described by the implementation manners provided in the following steps S11 to S14.
- the above-mentioned medical unit to be monitored may be any medical unit monitored by the medication monitoring unit, which may be specifically determined according to actual application scenarios, and is not limited herein.
- any medical unit may be monitored by the medication monitoring unit, so the selected monitoring object may be the medical unit to be monitored.
- the medical unit to be monitored will be described as an example below.
- the medication prescriptions of the above medical units may include all medication prescriptions generated by the medical unit to be monitored within a single day.
- all medication prescriptions generated by the above-mentioned medical unit to be monitored within a single day can be explained by taking a single-day prescription as an example.
- the single-day prescription of the above medical unit may refer to all prescriptions issued by the medical unit on any day, including but not limited to all prescriptions issued by all doctors in all departments of the hospital within a single day, and all doctors in a department of the hospital within a single day All prescriptions issued, or any prescriptions issued by a physician in a department of a hospital within a single day.
- the specific conditions indicated by the above single-day prescriptions are based on the evaluation dimension of the medical unit's medication monitoring in the actual application scenario (for example, the medical unit's medication monitoring, the medical unit's medication monitoring for a medical department, or the medical unit's medication monitoring A certain doctor in a department carries out medication monitoring, etc.), and it is not restricted here.
- the following will take all prescriptions issued by all doctors in all departments of the hospital within a single day as an example, hereinafter referred to as a single-day prescription.
- the terminal device can be docked with the data system of the medical unit to be monitored to obtain the access qualification of the data system of the medical unit to be monitored, and from the medical system to be monitored based on the data system access qualification of the medical unit to be monitored
- the unit's data system obtains the prescription of the medical unit to be monitored, for example, the single-day prescription of the medical unit to be monitored.
- the terminal device may also screen out the medical claim data such as the single-day prescription of the medical unit from the medical claim data.
- the terminal device can also obtain prescription data such as the single-day prescription of the medical unit to be monitored from the medical records of patients in each medical unit based on big data analysis, and so on.
- the terminal device may obtain a single-day prescription of the medical unit to be monitored based on any data acquisition path other than the above-mentioned data acquisition method, which may be determined according to actual application scenarios, without limitation.
- any single prescription of the medical unit to be monitored here can include the details of the drugs prescribed in the prescription, including but not limited to the name of the drug, the amount of the drug, the way of using the drug (or the method of taking the drug, etc.) ) And the number of days the drug is used can be determined according to the actual application scenario, and is not limited here.
- the drug information of each drug included in all prescriptions of the single-day prescription of the medical unit to be monitored may be determined, wherein the drug information of any drug includes but not Limited to the amount of medicine and days of medicine use.
- the drug information of each drug included in all prescriptions in the single-day prescription of the medical unit to be monitored the total number of drugs included in the single-day prescription of the medical unit to be monitored, the total amount of drugs, and the total number of days of drug use, etc. can be determined.
- the drug amount of any of the above drugs is the price of a single drug by multiplying the unit price and quantity of any drug.
- the above-mentioned total number of medicines represents the total number of medicines used in all prescriptions in a single-day prescription after accumulation.
- the total amount of the above drugs is based on the unit price and quantity of each drug included in the single-day prescription to obtain the drug amount of the single drug, and then the drug amounts of all the drugs included in the single-day prescription are accumulated to obtain the drugs of all drugs
- the total price ie the total amount of medicine.
- the total number of days of use of the above drugs is the cumulative value of the number of days of use of each drug in all drugs in a single-day prescription.
- the average daily drug cost of the single-day prescription of the medical unit to be monitored represents the average cost of all drugs included in the single-day prescription of the medical unit to be monitored.
- the average daily drug cost can be explained. Among them, the average daily drug cost of the single-day prescription of the medical unit to be monitored can be calculated based on the following formula (1):
- Average daily drug cost total drug / total days of drug use.
- the total amount of medicines in the above formula (1) is the total price of all medicines obtained by accumulating the medicine amounts of all medicines in a single day prescription
- the total number of days of use of the above medicines is the number of days of use of each medicine in all medicines in a single day prescription Accumulated value.
- S13 Determine whether the medication used by the medical unit to be monitored exceeds the standard according to the daily average drug cost and the daily average drug cost threshold corresponding to the medical unit to be monitored.
- the evaluation index thresholds of the drug monitoring standards and / or drug evaluation standards of each medical unit may be preset.
- the threshold of the above assessment index may be the threshold of the daily average drug cost, for example, the upper limit of the daily average drug cost, or the upper limit of the daily average drug cost.
- the daily average drug cost limit corresponding to the medical unit to be monitored can be set based on the historical drug record or drug use policy of the medical unit to be monitored, and then based on the above determined to be monitored.
- the average daily drug cost of a medical unit, combined with the threshold of the assessment index corresponding to the medical unit to be monitored determines whether the medical unit's medication exceeds the standard. In other words, whether the average daily drug cost of the medical unit to be monitored is greater than its corresponding daily average drug cost ceiling.
- the average daily drug cost of the medical unit to be monitored is less than or equal to the upper limit of the corresponding average daily drug cost, it can be determined that the medical unit to be monitored is in compliance with the standard, that is, the medical unit to be monitored does not exceed the standard. If the average daily drug cost of the medical unit to be monitored is greater than its corresponding daily average drug cost upper limit, it can be determined that the medical unit of the medical unit to be monitored exceeds the standard, that is, the medical cost of the medical unit to be monitored exceeds the standard.
- the above-mentioned medical unit to be monitored exceeds the standard, for example, the average daily drug cost of the medical unit is greater than the daily average drug cost threshold, it can be determined that the daily average drug cost of the above-mentioned medical unit to be monitored exceeds the daily average The daily average drug cost difference in the drug cost threshold. Based on the above average daily drug cost difference, the above average daily drug cost and / or the above average daily drug cost difference can be publicized.
- the medical unit to be monitored Based on the announced daily average drug cost and / or daily average drug cost difference, the medical unit to be monitored The doctor controls the prescription medication, avoids the waste of medicine and other medical resources caused by the doctors of the medical unit to be monitored during the prescription, and realizes the risk control of the drug cost exceeding the standard of the prescription of the monitoring medical unit.
- the daily average drug cost and / or daily average drug cost difference it can be publicized on the announcement interface of the unit lobby of the medical unit to be monitored (such as the message announcement display screen of the unit lobby) or at the drug regulatory agency.
- the medical unit ’s daily drug monitoring daily report is published to control the medications of the medical unit to be monitored and its various doctors ’prescriptions, to avoid the waste of medical resources caused by the continuous daily exceeding of the standard drug cost of the drug prescriptions of the medical unit to be monitored, and to achieve Risk control of overdose of the medical unit to be monitored.
- it can also be publicized on the information announcement interface of each department of the medical unit to be monitored, and / or each physician of the medical unit to be monitored It is publicized on the homepage of the prescribing tool, which can be determined according to the actual application scenario, without limitation.
- the daily average drug cost of the medical unit to be monitored can be determined based on the drug information included in the medication prescription of the medical unit to be monitored, and then the medication of the medical unit to be monitored can be determined based on the average daily drug cost of the medical unit to be monitored Whether it exceeds the standard, to realize the evaluation of the medication index of the medical unit to be monitored, and the operation is simple. Based on the method provided in the embodiments of the present application, it is simple to implement the medication monitoring operation of each medical unit, which can improve the accuracy of the medication monitoring of the medical unit, improve the reliability of the medication monitoring of the medical unit, and further improve the The use of medicines is to make public the prescription of each medical unit.
- the daily drug cost exceeds the standard.
- the reliability of the drug prescription risk control of drug prescriptions exceeding the standard improve the controllability of the prescription of the medical unit, so that the effective utilization of medical resources can be improved. , More applicable.
- FIG. 2 is another schematic flowchart of a data processing-based drug prescription risk control method provided by an embodiment of the present application.
- the data prescription-based drug prescription risk control method provided by the embodiments of the present application can realize the monitoring of the medication situation of the medical unit to be monitored in a single assessment cycle.
- the method can be implemented by the implementation methods provided in the following steps S21 to S25 Instructions.
- the implementation manner of obtaining the medication prescription of the medical unit to be monitored may refer to the implementation manner provided in step S11 in the foregoing embodiment, and details are not described herein again.
- the medication prescription of the medical unit may further include all medication prescriptions generated by the medical unit to be monitored within a single assessment cycle, wherein the single assessment cycle is greater than one day, such as one week, one Months, quarters, or years, etc., no restrictions here.
- the single assessment cycle is greater than one day, such as one week, one Months, quarters, or years, etc., no restrictions here.
- all medication prescriptions generated by the above-mentioned medical unit to be monitored in a single assessment cycle can be illustrated by taking a single assessment cycle prescription as an example.
- the single assessment cycle prescription of the medical unit may refer to all prescriptions issued in any assessment cycle of the medical unit, including but not limited to all prescriptions issued by all doctors in all departments of the hospital in a single assessment cycle, and a single All the prescriptions issued by all the doctors in a certain department of the hospital during the assessment cycle, or all the prescriptions issued by a certain doctor in a certain department of the hospital in a single assessment cycle.
- the specific conditions indicated in the above single assessment cycle prescriptions are based on the evaluation dimensions of drug monitoring of medical units in actual application scenarios (for example, drug monitoring for medical units, drug monitoring for a department of the medical unit, or A certain doctor in a certain department conducts medication monitoring, etc.), and it is not restricted here.
- the following will take all prescriptions issued by all doctors in all departments of the hospital in a single assessment cycle as an example for explanation, hereinafter referred to as a single assessment cycle prescription.
- any prescription included in the single assessment cycle prescription of the medical unit to be monitored here can include the details of the drugs prescribed in the prescription, including but not limited to the name of the drug, the amount of the drug, the method of use of the drug and the use of the drug
- the number of days can be determined according to the actual application scenario, without limitation.
- the average daily drug cost based on the prescription of the medical unit to be monitored may also be processed to obtain the average daily drug cost of the medical unit to be monitored within a specified time period, for example, one week, one The average daily drug cost per month, quarter or year.
- a specified time period for example, one week, one The average daily drug cost per month, quarter or year.
- the following can be used as an assessment cycle for a week, taking the average daily drug cost of a week as an example for explanation, referred to as the average daily drug cost for prescriptions in a single assessment cycle.
- the average daily drug cost for a single assessment cycle prescription can meet the following formula (2):
- Average daily drug cost total periodical drug / total days of periodical drug use.
- the total amount of periodic drugs can be the total amount of all drugs obtained by accumulating the amounts of all drugs included in all prescriptions in a single assessment cycle, and the total number of days of use of the above-mentioned periodic drugs can be a single assessment cycle The cumulative value of the number of days of use of each drug in all drugs included in the prescription.
- the medication prescription of any day within a single assessment cycle can be obtained (for convenience of description, the following will A single-day medication prescription is taken as an example), and the drug information of each drug included in any single-day medication prescription is obtained, where the drug information includes but is not limited to the amount of drugs and the number of days of use of the drugs.
- Determine the daily average drug cost for any day of the medical unit to be monitored according to the drug amount and the number of days of drug use included in any single-day drug prescription (for convenience of description, the following will take the single-day daily drug cost as an example for explanation ).
- the daily average daily drug cost of any day of the medical unit to be monitored may refer to the implementation manner corresponding to formula (1) in the foregoing embodiment, and details are not described herein again.
- the total number of days of drug use in the daily prescription can be determined, and then the waiting period can be determined based on the total number of days of drug use in the daily prescription Monitor the total days of drug use for all drugs included in the single assessment cycle prescription of the medical unit.
- the total number of days of drug use on any day within a single assessment period of the medical unit to be monitored is the sum of the number of days of drug use of each drug included in any single-day prescription.
- the average daily drug cost of the medical unit to be monitored within a single evaluation cycle can be determined.
- the cumulative value of the average daily drug cost per day in a single evaluation cycle of the medical unit to be monitored can be determined according to the daily average daily drug cost of each day in the single evaluation cycle.
- the accumulated value of the average daily drug cost According to the total number of days of drug use in each day of the single assessment cycle, the accumulated value of the total number of days of drug use in the single assessment period of the medical unit to be monitored can be determined.
- the daily average drug cost of the medical unit to be monitored is determined according to the cumulative value of the above-mentioned average daily daily drug cost and the cumulative value of the above-mentioned total days of drug use.
- the average daily drug cost of the medical unit to be monitored (that is, the average daily drug cost of the medical unit to be monitored in a single assessment cycle) can satisfy the following formula (3):
- Daily average drug cost cumulative value of daily average daily drug cost / cumulative value of total days of drug use.
- the cumulative value of the average daily drug cost in the above formula (3) may be the cumulative average of the daily drug cost of each single-day prescription in 7 single-day prescriptions within a week Value
- the cumulative value of the total number of days of drug use in the above formula (3) may be the cumulative value of the total number of days of drug use in each of the 7 single-day prescriptions within a week.
- S23 Determine the upper limit of the average daily drug cost of the medical unit to be monitored according to the unit attribute information of the medical unit to be monitored.
- the specific implementation manner of determining whether the medication of the medical unit to be monitored meets the standard according to the daily average drug cost of the medical unit to be monitored and the daily average drug cost threshold corresponding to the medical unit to be monitored can be found in the above embodiment
- the implementation method provided in step S13 in FIG. 3 will not be described here.
- the evaluation index thresholds of the drug monitoring standards and / or drug evaluation standards of each medical unit may also be determined based on the unit attribute information of each medical unit, That is, the daily average drug cost threshold, such as the upper limit of the daily average drug cost.
- the unit attribute information of the medical unit to be monitored includes one or more of the unit type, the region where the unit is located, the city where the unit is located, the unit drug supply channel, and the number of patients of the unit, which can be determined according to the actual application scenario. There are no restrictions here. For example, based on different medical units associated with parameters such as different regions, different cities, different drug supply channels, or different patient flows, the evaluation thresholds for drug monitoring may vary.
- the upper limit of the average daily drug cost can be set higher. That is, the threshold of the assessment index of the corresponding medication monitoring standard can be set to a higher assessment index.
- the upper limit of the average daily drug cost can be set lower, that is, its The threshold of the assessment index of the corresponding medication monitoring standard can be set to a lower assessment index.
- the medical unit to be monitored can be determined based on the above-mentioned average daily drug cost of the medical unit to be monitored, combined with the assessment index threshold (that is, the upper limit of the average daily drug cost) determined based on the unit attribute information of the medical unit to be monitored Whether the medication used exceeds the standard, in other words, whether the average daily drug cost of the medical unit to be monitored is greater than its corresponding daily average drug cost ceiling. If the average daily drug cost of the medical unit to be monitored is less than or equal to the upper limit of the corresponding daily average drug cost, it can be determined that the medication of the medical unit to be monitored does not exceed the standard, otherwise the drug of the medical unit is over-standard.
- the assessment index threshold that is, the upper limit of the average daily drug cost
- the risk of the drug prescription of the medical unit to be monitored exceeding the standard is controlled based on the average daily drug cost of the medical unit to be monitored.
- the daily average drug cost difference of the over-standard part of the medical unit to be monitored is publicized to realize the risk that the medical cost of the medical unit to be monitored exceeds the standard
- the pending monitoring when receiving the drug expense reimbursement request or the drug expense claim request submitted by the medical unit to be monitored, the pending monitoring can be rejected
- a medical unit ’s request for reimbursement of drug expenses or a claim for claim for medical expenses shall be punished for the assessment standard of the daily medical cost of the medical unit to be monitored exceeding the standard, so as to control the risk of drug costs for the medical unit.
- the medical unit may be fed back the medical cost of all prescriptions for that day Reimbursement failed.
- the terminal device can feed back the medical unit's day when receiving the prescription drug cost reimbursement and / or claim request from the medical unit for that day Of the prescription drug costs refused to be reimbursed or settled, and the medical unit can be prompted to self-control the daily drug cost of the daily prescription to achieve the prescription risk control of the medical unit's drug cost exceeding the standard.
- the terminal device may calculate the medical unit to be monitored The difference between the average daily drug cost and the above average daily drug cost threshold.
- the terminal device may respond to the difference between the daily average medical cost of the medical unit to be monitored and the above-mentioned average daily drug cost threshold To monitor the medical unit's single-day prescription drug cost difference in part of the drug cost refusal to reimburse or settle claims in order to carry out prescription risk control of the medical unit's drug cost exceeding the standard.
- the terminal device when the terminal device determines that the prescribed medication within a certain evaluation period (for example, one day or one week, etc.) of the medical unit to be monitored exceeds the standard, for example, within a certain evaluation period of the medical unit to be monitored
- a certain evaluation period for example, one day or one week, etc.
- the terminal device can be next evaluated after the evaluation cycle (the daily average drug cost of a single-day prescription exceeds a certain day, such as Monday)
- the daily average drug cost excessive report of the assessment cycle is transmitted to the medical unit to be monitored.
- the daily average drug cost exceeding report is used to remind the medical unit to be monitored to exceed the standard within the evaluation period, and can also remind the medical unit to be monitored if it is within the next evaluation period or multiple consecutive evaluation periods within the specified time. If the average drug cost still exceeds the standard, the medical unit to be monitored will be punished for exceeding the daily drug cost.
- the above-mentioned punishment includes the refusal to reimburse or settle all the daily average medical expenses for the medical unit to be monitored, or the refusal to reimburse or claim the excessive daily medical expenses of the medical unit to be monitored.
- the above-mentioned daily average drug cost exceeding report is used to prompt the medical unit to be monitored to control the daily average drug cost in order to realize the risk control of the medical cost of the medical unit to be monitored exceeding the standard
- the embodiment of the present application may determine the average daily drug cost of the medical unit to be monitored in a single evaluation cycle based on the drug information included in the medication prescription of the medical unit to be monitored in a single evaluation cycle.
- the single evaluation cycle includes a single day
- the assessment period includes any period longer than one day. Based on the average daily drug cost of the medical unit to be monitored during the assessment period, it is judged whether the medical unit to be monitored meets the standard, and the evaluation of the medical index of the medical unit to be monitored is realized, and the operation methods are diverse.
- the medical drug monitoring operation modes of various medical units are various, which can not only improve the accuracy of medical drug monitoring of medical units, but also improve the reliability of medical drug monitoring of medical units, and can also enhance the medical treatment of medical units.
- the operational flexibility of the unit's medication monitoring can further improve the publicity of the prescription of each medical unit based on the medication situation of each medical unit, and / or reject the drug cost reimbursement and / or claims for the corresponding daily average drug cost exceeding the standard
- the reliability of the risk control when the medication is exceeded can improve the controllability of the medication prescribed by the medical unit, thereby improving the effective utilization of medical resources and making it more applicable.
- FIG. 3 is a schematic structural diagram of an embodiment of a drug prescription risk control device based on data processing provided by an embodiment of the present application.
- the medicine prescription risk control device based on data processing provided by the embodiments of the present application includes:
- the data obtaining unit 31 is used to obtain the medication prescription of the medical unit to be monitored.
- the medicine information processing unit 32 is configured to obtain the medicine information included in the medicine prescription obtained by the data obtaining unit, and determine the daily average medicine cost of the medical unit to be monitored according to the medicine information.
- the medication monitoring unit 33 is configured to determine whether the medication used by the medical unit to be monitored exceeds the standard according to the daily average drug cost determined by the drug information processing unit and the daily average drug cost threshold corresponding to the medical unit to be monitored.
- the medication risk control unit 34 is configured to, when the medication monitoring unit determines that the medication of the medical unit to be monitored exceeds the standard, based on the daily average drug cost determined by the drug information processing unit, the drug prescription of the medication unit to be monitored may exceed the standard risk control.
- the data acquisition unit 31 is used to:
- the medication prescription of the medical unit to be monitored includes all medication prescriptions of the medical unit to be monitored in a single assessment cycle, and the duration of the single assessment cycle includes a single day or multiple days.
- the medication prescription of the medical unit to be monitored includes all prescriptions of the medication of the medical unit to be monitored within a single assessment cycle on a single day;
- the above drug information processing unit 32 is used to:
- the above drug information includes at least the drug amount and the number of days the drug is used;
- Average daily drug cost total drug / total days of drug use.
- the drug prescriptions of the medical unit to be monitored include all drug prescriptions of the medical unit to be monitored in a single assessment period of multiple days;
- the above drug information processing unit 32 is used to:
- the above-mentioned drug information includes at least the drug amount and the number of days of drug use;
- the total number of days of drug use for any one day is the sum of the number of days of drug use for each drug included in any one-day medication prescription.
- the above-mentioned drug information processing unit 32 is used to:
- Daily average drug cost cumulative value of daily average daily drug cost / cumulative value of total days of drug use.
- the threshold of the average daily drug cost corresponding to the medical unit to be monitored includes the upper limit of the average daily drug cost corresponding to the medical unit to be monitored;
- the above medication monitoring unit 33 is used for:
- the unit attribute information of the medical unit to be monitored includes one or more of the unit type, the region where the unit is located, the city where the unit is located, the drug supply channel of the unit, and the number of patients of the unit.
- the above-mentioned medication risk control unit 34 is used to:
- the above-mentioned data processing-based medication prescription risk control device may execute the implementation manners provided by the above steps in FIGS. 1 to 2 through various built-in functional modules.
- the above medication processing risk control device based on data processing may be the terminal device described in each of the foregoing embodiments, which is not limited herein.
- the above-mentioned data acquisition unit 31 may be used to perform the acquisition of the medication prescription of the medical unit to be monitored in each of the above steps.
- the implementation manner provided in each of the above steps and details are not described herein again.
- the above-mentioned drug information processing unit 32 may be used to implement the drug amount of each drug included in the drug prescription of the medical unit to be monitored in the above steps, the average daily drug cost per day, and / or the average daily drug cost to the medical unit to be monitored, etc.
- the average daily drug cost per day may be monitored in the above steps.
- the above-mentioned medication monitoring unit 33 can be used to perform the above-mentioned various steps to determine the evaluation index threshold for medication monitoring such as the daily average drug cost upper limit of the medical unit to be monitored based on the unit attribute information of the medical unit to be monitored, and the daily average medicine based on the medical unit to be monitored.
- the above-mentioned medication risk control unit 34 is used to implement the implementation method of the risk control of over-standard drug costs for the medical prescription of the medical unit to be monitored based on the above-mentioned average daily drug cost determined by the above-mentioned drug information processing unit 32. The method will not be repeated here.
- the above drug monitoring device may determine the average daily drug cost of the medical unit to be monitored in a single evaluation cycle based on the drug information included in the drug prescription of the medical unit to be monitored in a single evaluation cycle, here a single
- the assessment cycle includes a single day, and also includes any period longer than one day. Based on the average daily drug cost of the medical unit to be monitored during the assessment period, it is judged whether the medical unit to be monitored meets the standard, and the evaluation of the medical index of the medical unit to be monitored is realized, and the operation methods are diverse.
- the medical drug monitoring operation modes of various medical units are various, which can not only improve the accuracy of medical drug monitoring of medical units, but also improve the reliability of medical drug monitoring of medical units, and can also enhance the
- the operational flexibility of the unit's medication monitoring can further improve the publicity of the prescription of each medical unit based on the medication situation of each medical unit, and / or reject the drug cost reimbursement and / or claims for the corresponding daily average drug cost exceeding the standard
- the reliability of the risk control when the medication is exceeded can improve the controllability of the medication prescribed by the medical unit, thereby improving the effective utilization of medical resources and making it more applicable.
- FIG. 4 is a schematic structural diagram of an embodiment of a terminal device provided by an embodiment of the present application.
- the terminal device in this embodiment may include: one or more processors 401 and a memory 402.
- the processor 401 and the memory 402 are connected via a bus 403.
- the memory 402 is used to store a computer program, and the computer program includes program instructions, and the processor 401 is used to execute the program instructions stored in the memory 402.
- the processor 401 is configured to call the program instruction to perform the following operations:
- the above-mentioned daily average drug cost and the above-mentioned average daily drug cost threshold corresponding to the medical unit to be monitored determine whether the medication of the medical unit to be monitored exceeds the standard
- the drug cost of the above-mentioned medical unit to be monitored will be controlled based on the daily average drug cost.
- the foregoing processor 401 is configured to:
- the medicine prescription of the medical unit to be monitored includes all prescriptions of the medicine of the medical unit to be monitored within a single day, or all prescriptions of the medicine of the medical unit to be monitored within a single evaluation period, and the single evaluation period is greater than one day.
- the medication prescription of the medical unit to be monitored includes all prescriptions of the medication of the medical unit to be monitored within a single assessment cycle on a single day;
- the above processor 401 is used to:
- the above drug information includes at least the drug amount and the number of days the drug is used;
- Average daily drug cost total drug / total days of drug use.
- the drug prescriptions of the medical unit to be monitored include all drug prescriptions of the medical unit to be monitored in a single assessment period of multiple days;
- the above processor 401 is used to:
- the above-mentioned drug information includes at least the drug amount and the number of days of drug use;
- the total number of days of drug use for any one day is the sum of the number of days of drug use for each drug included in any one-day medication prescription.
- the foregoing processor 401 is configured to:
- the daily average drug cost of the medical unit to be monitored is determined according to the cumulative value of the above-mentioned daily average daily drug cost and the cumulative value of the above-mentioned total days of drug use.
- Daily average drug cost cumulative value of daily average daily drug cost / cumulative value of total days of drug use.
- the daily medical expenses of the medical unit to be monitored meet:
- Average daily drug cost total periodical drugs / total days of periodical drugs
- the total amount of medicines in the above period may be the total amount of all medicines obtained by accumulating the amount of all prescription medicines in a single assessment period, and the total number of days of use of the above period medicines may be each medicine in all medicines in a single assessment period The cumulative value of the number of days of medicine used.
- the threshold of the average daily drug cost corresponding to the medical unit to be monitored includes the upper limit of the average daily drug cost corresponding to the medical unit to be monitored;
- the above processor 401 is used to:
- the unit attribute information of the medical unit to be monitored includes one or more of the unit type, the region where the unit is located, the city where the unit is located, the drug supply channel of the unit, and the number of patients of the unit.
- the foregoing processor 401 is used to:
- the above-mentioned drug cost reimbursement request is rejected in order to realize the risk control of the drug cost exceeding the prescription of the drug prescription.
- the processor 401 may be a central processing unit (CPU), and the processor may also be other general-purpose processors, digital signal processors (DSPs), and dedicated integrations. Circuit (application specific integrated circuit, ASIC), ready-made programmable gate array (field-programmable gate array, FPGA) or other programmable logic devices, discrete gate or transistor logic devices, discrete hardware components, etc.
- the general-purpose processor may be a microprocessor or the processor may be any conventional processor or the like.
- the memory 402 may include a read-only memory and a random access memory, and provide instructions and data to the processor 401. A portion of the memory 402 may also include non-volatile random access memory. For example, the memory 402 may also store device type information.
- the above-mentioned terminal device may execute the implementation manners provided by the steps in FIG. 1 to FIG. 2 through the function modules of the built-in processor 401.
- the above-mentioned terminal device may execute the implementation manners provided by the steps in FIG. 1 to FIG. 2 through the function modules of the built-in processor 401.
- the implementation manners provided by the above steps And will not be repeated here.
- the terminal device may determine the average daily drug cost of the medical unit to be monitored in a single evaluation cycle based on the drug information included in the medication prescription of the medical unit to be monitored in a single evaluation cycle This includes a single day, and any period longer than one day. Based on the average daily drug cost of the medical unit to be monitored during the assessment period, it is judged whether the medical unit to be monitored meets the standard, and the evaluation of the medical index of the medical unit to be monitored is realized, and the operation methods are diverse.
- the medical drug monitoring operation modes of various medical units are various, which can not only improve the accuracy of medical drug monitoring of medical units, but also improve the reliability of medical drug monitoring of medical units, and can also enhance the medical treatment of medical units.
- the operational flexibility of the unit's medication monitoring can further improve the publicity of the prescription of each medical unit based on the medication situation of each medical unit, and / or reject the drug cost reimbursement and / or claims for the corresponding daily average drug cost exceeding the standard
- the reliability of the risk control when the medication is exceeded can improve the controllability of the medication prescribed by the medical unit, thereby improving the effective utilization of medical resources and making it more applicable.
- Embodiments of the present application also provide a computer-readable storage medium that stores a computer program, and the computer program includes program instructions, which are executed by a processor to implement the steps in FIGS. 1 to 2.
- the data prescription-based drug prescription risk control method provided can be referred to the implementation provided in the above steps, which will not be repeated here.
- the foregoing computer-readable storage medium may be the data processing-based medication prescription risk control device provided in any of the foregoing embodiments or the internal storage unit of the foregoing terminal device, such as a hard disk or memory of an electronic device.
- the computer-readable storage medium may also be an external storage device of the electronic device, such as a plug-in hard disk equipped on the electronic device, a smart memory card (smart media card, SMC), a secure digital (SD) card, Flash card (flash card), etc.
- the computer-readable storage medium may also include both an internal storage unit of the electronic device and an external storage device.
- the computer-readable storage medium is used to store the computer program and other programs and data required by the electronic device.
- the computer-readable storage medium can also be used to temporarily store data that has been or will be output.
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Abstract
Description
Claims (20)
- 一种基于数据处理的用药处方风险控制方法,其特征在于,所述方法包括:获取待监控医疗单位的用药处方;获取所述用药处方中所包括的药品信息,并根据所述药品信息确定所述待监控医疗单位的日均药品费用;根据所述日均药品费用和所述待监控医疗单位对应的日均药品费用阈值,确定所述待监控医疗单位的用药是否超标;若所述待监控医疗单位的用药超标,则基于所述日均药品费用对所述待监控医疗单位进行用药处方的药品费用超标风险控制。
- 根据权利要求1所述的方法,其特征在于,所述获取待监控医疗单位的用药处方包括:获取所述待监控医疗单位的数据系统准入资格,基于所述数据系统准入资格从所述待监控医疗单位的数据系统中获取所述待监控医疗单位的用药处方;和/或获取所述待监控医疗单位提供的医疗理赔数据,从所述医疗理赔数据中获取所述待监控医疗单位的用药处方;其中,所述待监控医疗单位的用药处方包括所述待监控医疗单位在单个考核周期内的所有用药处方,所述单个考核周期的周期时长包括单日或者多日。
- 根据权利要2所述的方法,其特征在于,所述待监控医疗单位的用药处方包括所述待监控医疗单位在单日的单个考核周期内的所有用药处方;所述获取所述用药处方中所包括的药品信息,并根据所述药品信息确定所述待监控医疗单位的日均药品费用包括:获取所述所有用药处方中所包括的各药品的药品信息,所述药品信息中至少包括药品金额和药品使用天数;根据所述各药品的药品金额确定所述所有用药处方所包括的所有药品的药品总额,并根据所述各药品的药品使用天数确定所述所有用药处方的药品使用总天数;根据所述药品总额和所述药品使用总天数确定所述待监控医疗单位的日均药品费用。
- 根据权利要求2所述的方法,其特征在于,所述待监控医疗单位的用药处方包括所述待监控医疗单位在多日的单个考核周期内的所有用药处方;所述获取所述用药处方中所包括的药品信息,并根据所述药品信息确定所述待监控医疗单位的日均药品费用包括:获取所述单个考核周期内任一日的任一单日用药处方,并获取所述任一单日用药处方中所包括的各药品的药品信息,所述药品信息中至少包括药品金额和药品使用天数;根据所述任一单日用药处方所包括的各药品的药品金额和药品使用天数确定所述待监控医疗单位的单日日均药品费用;根据所述待监控医疗单位在所述单个考核周期内各日的单日日均药品费用和药品使用总天数确定所述待监控医疗单位的日均药品费用;其中,任一日的药品使用总天数为所述任一单日用药处方中所包括的各药品的药品使 用天数的总和。
- 根据权利要求4所述的方法,其特征在于,所述根据所述待监控医疗单位在所述单个考核周期内各日的单日日均药品费用和药品使用总天数确定所述待监控医疗单位的日均药品费用包括:根据所述单个考核周期内各日的单日日均药品费用确定所述单个考核周期的单日日均药品费用累加值,根据所述单个考核周期内各日的药品使用总天数确定所述单个考核周期内的药品使用总天数累加值;根据所述单日日均药品费用累加值和所述药品使用总天数累加值确定所述待监控医疗单位的日均药品费用。
- 根据权利要求3或4所述的方法,其特征在于,所述待监控医疗单位对应的日均药品费用阈值包括所述待监控医疗单位对应的日均药品费用上限;所述根据所述日均药品费用和所述待监控医疗单位对应的日均药品费用阈值,确定所述待监控医疗单位的用药是否超标包括:根据所述待监控医疗单位的单位属性信息确定所述待监控医疗单位的所述日均药品费用上限;若所述待监控医疗单位的日均药品费用小于或者等于所述日均药品费用上限,则确定所述待监控医疗单位的用药不超标;若所述待监控医疗单位的日均药品费用大于所述日均药品费用上限,则确定所述待监控医疗单位的用药超标;其中,所述待监控医疗单位的单位属性信息包括单位类型、单位所处地域、单位所处城市、单位药品供应渠道以及单位病患人次中的一种或多种。
- 根据权利要求1-6任一项所述的方法,其特征在于,所述基于所述日均药品费用对所述待监控医疗单位进行用药处方的药品费用超标风险控制包括:将所述日均药品费用和/或所述日均药品费用超出所述日均药品费用阈值的差值进行公示,基于公示的所述日均药品费用和/或所述差值提示所述待监控医疗单位控制开方的用药,以实现用药处方的药品费用超标风险控制;和/或当接收到所述日均药品费用和/或所述差值对应的药品费用报销请求时,拒绝所述药品费用报销请求以实现用药处方的药品费用超标风险控制。
- 一种基于数据处理的用药处方风险控制装置,其特征在于,所述装置包括:数据获取单元,用于获取待监控医疗单位的用药处方;药品信息处理单元,用于获取所述数据获取单元获取的所述用药处方中所包括的药品信息,并根据所述药品信息确定所述待监控医疗单位的日均药品费用;用药监控单元,用于根据所述药品信息处理单元确定的所述日均药品费用和所述待监控医疗单位对应的日均药品费用阈值,确定所述待监控医疗单位的用药是否超标;用药风险控制单元,用于在所述用药监控单元确定所述待监控医疗单位的用药超标时,基于所述药品信息处理单元确定的所述日均药品费用对所述待监控医疗单位进行用药处方的药品费用超标风险控制。
- 根据权利要求8所述的装置,其特征在于,所述数据获取单元用于:获取所述待监控医疗单位的数据系统准入资格,基于所述数据系统准入资格从所述待监控医疗单位的数据系统中获取所述待监控医疗单位的用药处方;和/或获取所述待监控医疗单位提供的医疗理赔数据,从所述医疗理赔数据中获取所述待监控医疗单位的用药处方;其中,所述待监控医疗单位的用药处方包括所述待监控医疗单位在单个考核周期内的所有用药处方,所述单个考核周期的周期时长包括单日或者多日。
- 根据权利要求9所述的装置,其特征在于,所述待监控医疗单位的用药处方包括所述待监控医疗单位在单日的单个考核周期内的所有用药处方;所述药品信息处理单元用于:获取所述所有用药处方中所包括的各药品的药品信息,所述药品信息中至少包括药品金额和药品使用天数;根据所述各药品的药品金额确定所述所有用药处方所包括的所有药品的药品总额,并根据所述各药品的药品使用天数确定所述所有用药处方的药品使用总天数;根据所述药品总额和所述药品使用总天数确定所述待监控医疗单位的日均药品费用。
- 根据权利要求9所述的装置,其特征在于,所述待监控医疗单位的用药处方包括所述待监控医疗单位在多日的单个考核周期内的所有用药处方;所述药品信息处理单元用于:获取所述单个考核周期内任一日的任一单日用药处方,并获取所述任一单日用药处方中所包括的各药品的药品信息,所述药品信息中至少包括药品金额和药品使用天数;根据所述任一单日用药处方所包括的各药品的药品金额和药品使用天数确定所述待监控医疗单位的单日日均药品费用;根据所述待监控医疗单位在所述单个考核周期内各日的单日日均药品费用和药品使用总天数确定所述待监控医疗单位的日均药品费用;其中,任一日的药品使用总天数为所述任一单日用药处方中所包括的各药品的药品使用天数的总和。
- 根据权利要求11所述的装置,其特征在于,所述药品信息处理单元用于:根据所述单个考核周期内各日的单日日均药品费用确定所述单个考核周期的单日日均药品费用累加值,根据所述单个考核周期内各日的药品使用总天数确定所述单个考核周期内的药品使用总天数累加值;根据所述单日日均药品费用累加值和所述药品使用总天数累加值确定所述待监控医疗单位的日均药品费用。
- 根据权利要求10或11所述的装置,其特征在于,所述待监控医疗单位对应的日均药品费用阈值包括所述待监控医疗单位对应的日均药品费用上限;所述用药监控单元用于:根据所述待监控医疗单位的单位属性信息确定所述待监控医疗单位的日均药品费用上限;若所述待监控医疗单位的日均药品费用小于或者等于所述日均药品费用上限,则确定所述待监控医疗单位的用药不超标;若所述待监控医疗单位的日均药品费用大于所述日均药品费用上限,则确定所述待监控医疗单位的用药超标;其中,所述待监控医疗单位的单位属性信息包括单位类型、单位所处地域、单位所处城市、单位药品供应渠道以及单位病患人次中的一种或多种。
- 根据权利要求8-13任一项所述的装置,其特征在于,所述用药风险控制单元用于:将所述日均药品费用和/或所述日均药品费用超出日均药品费用阈值的差值进行公示,基于公示的所述日均药品费用和/或所述差值提示所述待监控医疗单位的医师控制开方的用药,以实现用药处方的药品费用超标风险控制;和/或当接收到所述日均药品费用和/或所述差值对应的药品费用报销请求时,拒绝所述药品费用报销请求以实现用药处方的药品费用超标风险控制。
- 一种终端设备,其特征在于,包括处理器和存储器,所述处理器和所述存储器相互连接,其中,所述存储器用于存储计算机程序,所述计算机程序包括程序指令,所述处理器被配置用于调用所述程序指令,执行如下操作:获取待监控医疗单位的用药处方;获取所述用药处方中所包括的药品信息,并根据所述药品信息确定所述待监控医疗单位的日均药品费用;根据所述日均药品费用和所述待监控医疗单位对应的日均药品费用阈值,确定所述待监控医疗单位的用药是否超标;若所述待监控医疗单位的用药超标,则基于所述日均药品费用对所述待监控医疗单位进行用药处方的药品费用超标风险控制。
- 根据权利要求15所述的终端设备,其特征在于,所述处理器用于:获取所述待监控医疗单位的数据系统准入资格,基于所述数据系统准入资格从所述待监控医疗单位的数据系统中获取所述待监控医疗单位的用药处方;和/或获取所述待监控医疗单位提供的医疗理赔数据,从所述医疗理赔数据中获取所述待监控医疗单位的用药处方;其中,所述待监控医疗单位的用药处方包括所述待监控医疗单位在单个考核周期内的所有用药处方,所述单个考核周期的周期时长包括单日或者多日。
- 根据权利要求16所述的终端设备,其特征在于,所述待监控医疗单位的用药处方包括所述待监控医疗单位在单日的单个考核周期内的所有用药处方;所述处理器用于:获取所述所有用药处方中所包括的各药品的药品信息,所述药品信息中至少包括药品金额和药品使用天数;根据所述各药品的药品金额确定所述所有用药处方所包括的所有药品的药品总额,并根据所述各药品的药品使用天数确定所述所有用药处方的药品使用总天数;根据所述药品总额和所述药品使用总天数确定所述待监控医疗单位的日均药品费用。
- 根据权利要求16所述的终端设备,其特征在于,所述待监控医疗单位的用药处方包括所述待监控医疗单位在多日的单个考核周期内的所有用药处方;所述处理器用于:获取所述单个考核周期内任一日的任一单日用药处方,并获取所述任一单日用药处方中所包括的各药品的药品信息,所述药品信息中至少包括药品金额和药品使用天数;根据所述任一单日用药处方所包括的各药品的药品金额和药品使用天数确定所述待监控医疗单位的单日日均药品费用;根据所述待监控医疗单位在所述单个考核周期内各日的单日日均药品费用和药品使用总天数确定所述待监控医疗单位的日均药品费用;其中,任一日的药品使用总天数为所述任一单日用药处方中所包括的各药品的药品使用天数的总和。
- 根据权利要求18所述的终端设备,其特征在于,所述处理器用于:根据所述单个考核周期内各日的单日日均药品费用确定所述单个考核周期的单日日均药品费用累加值,根据所述单个考核周期内各日的药品使用总天数确定所述单个考核周期内的药品使用总天数累加值;根据所述单日日均药品费用累加值和所述药品使用总天数累加值确定所述待监控医疗单位的日均药品费用。
- 一种计算机可读存储介质,其特征在于,所述计算机可读存储介质存储有计算机程序,所述计算机程序被处理器执行以实现权利要求1-7任一项所述的方法。
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