WO2020082802A1

WO2020082802A1 - Data processing-based drug expense risk control method and device

Info

Publication number: WO2020082802A1
Application number: PCT/CN2019/095037
Authority: WO
Inventors: 袁刚
Original assignee: 平安医疗健康管理股份有限公司
Priority date: 2018-10-22
Filing date: 2019-07-08
Publication date: 2020-04-30
Also published as: CN109524079A

Abstract

A data processing-based drug expense risk control method and device. The method comprises: obtaining a medication prescription of a medical unit to be monitored (S11); obtaining drug information of drugs comprised in the medication prescription, and determining a single drug daily average expense of each drug according to the drug information of the drugs (S12); determining a target drug according to the single drug daily average expense of each drug, and determining a target drug proportion according to the drug information of the drugs (S13); determining whether the medication of the medical unit to be monitored exceeds the standard according to the target drug proportion and a target drug proportion threshold corresponding to the medical unit to be monitored (S14); and if the medication of the medical unit to be monitored exceeds the standard, controlling the risk of the drug expense exceeding the standard on the medical unit to be monitored on the basis of the target drug proportion (S15). By using the present method, the accuracy of medication monitoring on a medical unit is improved, the reliability of medication monitoring on the medical unit is enhanced, the effective utilization rate of medical resources is improved, and the applicability is strong.

Description

Method and device for controlling drug expense risk based on data processing

This application requires the priority of the Chinese patent application filed on October 22, 2018 in the Chinese Patent Office, with the application number 201811233472.6 and the application name "Data processing-based drug cost risk control method and device", the entire contents of which are incorporated by reference In this application.

Technical field

This application relates to the field of medical technology, and in particular to a method and device for controlling drug expense risk based on data processing.

Background technique

At present, in order to standardize the medication standards of various medical units, circumvent large prescriptions, thereby avoiding the abuse and waste of drugs, and serve the purpose of reasonable treatment, various medication monitoring mechanisms have emerged. 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.

In the prior art, 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. Among them, the evaluation criteria for the above-mentioned average prescription cost are calculated by dividing the total prescription by the number of prescriptions. In the prior art, 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. Usually, 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. Large prescriptions with large totals are broken down into multiple small prescriptions with small total prescriptions to reduce the average cost of prescriptions, thereby avoiding the monitoring of large prescriptions. The implementation method of the prior art makes the loopholes of drug monitoring of each medical unit larger, the accuracy of drug monitoring of each medical unit is low, and the applicability is poor. In the prior art, the medication risk of the medical unit is not controlled based on the medication situation of the medical unit, and the waste of medical resources is serious.

Summary of the invention

The embodiments of the present application provide a method and device for controlling drug cost risk based on data processing. The operation is simple, which can improve the accuracy of drug monitoring of medical units, enhance the reliability of drug monitoring of medical units, and improve the effectiveness of medical resources. The utilization rate is more applicable.

In a first aspect, an embodiment of the present application provides a method for controlling drug expense risk based on data processing. The method includes:

Obtain medication prescriptions for medical units to be monitored;

Obtain the drug information of various types of drugs included in the above drug prescriptions, and determine the average daily drug cost of each type of drugs based on the drug information of the above types of drugs;

Determine the target drug in the above drug prescription based on the average daily drug cost of the above drugs, and determine the target drug proportion of the above drug in the above drug prescription based on the drug information of the above drugs;

According to the target drug proportion and the target drug proportion threshold corresponding to the medical unit to be monitored, determine whether the medication of the medical unit to be monitored exceeds the standard;

If the medication used by the medical unit to be monitored exceeds the standard, the risk of exceeding the drug cost of the medical unit to be monitored is controlled based on the target drug ratio.

In a second aspect, an embodiment of the present application provides a drug cost risk control device based on data processing. The drug monitoring device includes:

The data acquisition unit is used to acquire the medication prescription of the medical unit to be monitored;

The medicine information processing unit is used to obtain the medicine information of the medicines included in the medicine prescription obtained by the data acquisition unit, and determine the average daily drug cost of the medicines of the medicines according to the medicine information of the medicines;

The above-mentioned drug information processing unit is also used to determine the target drug in the above-mentioned drug prescription based on the average daily drug cost of the above-mentioned drugs, and determine the target drug in the above-mentioned drug prescription based on the drug information of the above-mentioned drugs Target drug ratio;

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 target drug ratio determined by the drug information processing unit and the target drug ratio threshold corresponding to the medical unit to be monitored;

The drug risk control unit is used to perform a risk control of the drug cost of the medical unit to be monitored based on the target drug ratio 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.

In a third aspect, 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, and 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.

According to a fourth 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.

Based on the method provided by the embodiments of the present application, 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.

BRIEF DESCRIPTION

FIG. 1 is a schematic flowchart of a method for controlling drug expense risk based on data processing provided by an embodiment of the present application;

2 is another schematic flow chart of a method for controlling drug expense risk based on data processing provided by an embodiment of the present application;

FIG. 3 is a schematic structural diagram of an embodiment of a drug cost 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.

detailed description

At present, the determination of valuable medicines in various regions is to determine the medicines whose unit price of the smallest packaging unit (such as a bottle, a pack, a box or a bag, etc.) exceeds a certain threshold as valuable medicines. However, this method does not take into account the number of days of use of the unit price of the smallest packaging unit for the determination of valuable drugs, so the possible drawback is that the same unit price of the drug or a low-priced drug or a high-priced drug is used for different days. Inverted situation with higher unit price but lower average daily price. For example, the price of a single drug box is 300 yuan, which is judged as a valuable drug according to the current method of judging precious drugs in various regions; the box of this valuable drug can be used for 30 days, that is, the average daily price of the drug is 10 yuan / day. The price of another single drug box is 120 yuan, which is judged to be non-precious drug according to the current method of judging precious drugs in various regions; the box of this drug can be used for 3 days, that is, the average daily price of the drug is 40 yuan / day. It can be seen that the average daily price of non-precious drugs judged according to the current method of judging precious drugs in various regions exceeds the average daily price of precious drugs. Obviously, this judgment method has a low accuracy rate for the evaluation of precious drugs, which makes precious There are large loopholes in the assessment of drugs.

In some feasible implementation manners, the target medicine provided by the embodiment of the present application may be a valuable medicine, and the determination method of the valuable medicine here is different from the above-mentioned current determination method of the valuable medicine in each region. Here, the valuable drug may be a drug whose daily average drug cost is high among various types of drugs included in the prescription and is ranked high in the daily average drug cost of various types of drugs included in the prescription. The following will take precious medicines as an example and describe in conjunction with the data processing based warning method for exceeding the warning of medicines provided by the embodiments of the present application. Correspondingly, the proportion of target drugs can be explained by taking the proportion of valuable drugs as an example, which will not be repeated below.

The embodiments of the present application provide a data processing-based drug cost risk control method, which can be based on the preciousness of various hospitals, departments of various hospitals, various clinics, and various medical units (or representatives (or teams) of medical units) of various hospitals The proportion of drugs to evaluate whether the medications of various medical units (including hospitals, departments, clinics or physicians) exceed the standard (or is unreasonable), and can publicize the prescriptions of the medical units based on the medical unit's use of drugs. / Or reject the risk control of over-standard drug costs such as drug reimbursements corresponding to drug cost reimbursement of expensive drugs, to avoid wasting medical resources. For the convenience of description, 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. For the convenience of description, the prescription will be described as an example below. Generally speaking, 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. In other words, whether it is a large prescription with a large total prescription, a small prescription with a small total prescription, or a prescription with more manifestations, 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. Based on the details of the drugs included in each prescription, it can be determined that the single-drug daily average drug cost is high and the top ranked drugs are valuable drugs, and then the proportion of the total cost of drugs in all prescriptions based on the cost of precious drugs (i.e. expensive Drug ratio) to determine whether the medication is reasonable. Therefore, whether it is a large prescription or a small prescription or other, it is inseparable from the drug details. Therefore, based on the proportion of valuable medicines of each medical unit, the evaluation of the medical standard of each medical unit was carried out using the average daily drug cost (ie, the average daily drug cost of a single drug) corresponding to each type of drug, while also considering the The cost ratio is simple, and the operation is simple and can better and more comprehensively cover the medication monitoring of each prescription of the medical unit. At the same time, based on the proportion of valuable drugs in medical units, the drug monitoring of each medical unit is more accurate and in place, which can improve the accuracy of drug monitoring of each medical unit, and thus can improve the prescription of each medical unit based on the use of each medical unit. Reliability of risk control for drug prescriptions for drug prescriptions such as drug reimbursement for drug prescriptions that exceed the proportion of valuable drugs, and / or rejection of drug costs corresponding to the proportion of precious drugs exceeding the standard, can improve the controllability of medication prescribed by the medical unit, which can improve The effective utilization rate of medical resources is more applicable.

In some feasible embodiments, the medical unit's medication usage can be monitored daily based on the medical unit's valuable drug ratio when the medical unit's medication is monitored, and then the medical unit's precious drug ratio can be settled daily, based on the daily precious drug ratio The medical unit's medication is monitored. Optionally, while monitoring the medication use of the medical unit based on the daily proportion of valuable drugs, a comprehensive evaluation of the medication use of the medical unit based on the cumulative multi-day medication monitoring situation, such as a week, month, quarter or One year, etc., can be determined according to the actual application scenario, without limitation. For the convenience of description, the following will be based on the calculation of the average daily drug cost and the proportion of valuable drugs for various types of drugs on any day (for convenience, the following will be explained as an example), which can be based on the daily proportion of valuable drugs and / Or the daily average drug cost evaluates the medical unit's drug use as an example, and describes the drug cost risk control method based on data processing provided in the embodiments of the present application.

The drug cost risk control method based on data processing provided in the embodiments of the present application can be executed by terminal devices associated with drug monitoring units such as the Drug Supervision Administration, the Health Commission, the Health and Health Commission, and medical claims 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. For convenience of description, the terminal device will be taken as an example for description below.

Example one:

Referring to FIG. 1, FIG. 1 is a schematic flowchart of a drug cost risk control method based on data processing provided by an embodiment of the present application. The drug cost risk control method based on data processing provided by the embodiments of the present application can be described by the implementation methods provided in the steps S11 to S15 as follows.

S11. Obtain the medication prescription of the medical unit to be monitored.

In some feasible implementation manners, 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. In other words, any medical unit may be monitored by the medication monitoring unit, so the selected monitoring object may be the medical unit to be monitored. For convenience of description, the medical unit to be monitored will be described as an example below.

In some feasible implementation manners, 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. For convenience of description, 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. Among them, 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. For convenience of description, 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.

In some feasible implementation manners, 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. Optionally, based on the medical claim data provided by 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. Optionally, 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.

It can be understood that 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.

S12. Obtain the drug information of the various types of drugs included in the above medication prescription, and determine the average daily drug cost of each type of drugs based on the drug information of the types of drugs.

In some feasible implementation manners, based on the single-day prescription of the medical unit to be monitored, 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. Based on 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. Among them, 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. Here, 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):

Formula (1): Average daily drug cost = total drug / total days of drug use.

Among them, 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, and 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. For convenience of description, hereinafter referred to as the average daily drug cost of the medical unit.

In some feasible implementation manners, based on the same principle as the above calculation method of the daily average drug cost of the medical unit, the terminal device can also calculate the daily average drug cost of each type of drug in the single-day prescription of the medical unit. Among them, the daily average drug cost of any kind of drugs will be described below as an example. Based on the single-day prescription of the medical unit to be monitored, the medicine information of all kinds of medicines included in all medicine prescriptions can be obtained, and the above-mentioned medicine information includes at least the medicine amount and the days of medicine use. Determine the total drug amount of any drug in the above single-day prescription and the total number of days of drug use of any of the above-mentioned drugs according to the drug information of each type of drug in the above single-day prescription. The total number of days of drug use for a class of drugs determines the average daily drug cost per drug for any of the above-mentioned types of drugs to obtain the average daily drug cost for each drug of the above categories. Among them, the calculation of the average daily drug cost of any of the above drugs can meet the following formula (2):

Formula (2): The average daily drug cost of a single drug = the total amount of drugs of any type of drug / the total number of days of drug use of any type of drug.

Among them, the total price of any kind of medicines in the above formula (2) is the total price of a single medicine of all medicines prescribed in a single day (for convenience of description to describe any kind of medicine), the total price of the single medicine The total number of days of use of any type of drug is the cumulative value of the number of days of use of that type of drugs in all drugs prescribed in a single day.

Based on the implementation provided by the above formula (2), combined with the drug information of various types of drugs included in the single-day prescription of the unit to be monitored, the average daily single-drug drugs of various types of drugs in the single-day prescription of the medical unit to be monitored can be determined The cost can be used to determine the valuable drugs in a single-day prescription based on the average daily drug cost of each type of drug.

S13. Determine the target drug in the above-mentioned drug prescription based on the average daily drug cost of the above-mentioned drugs, and determine the target drug proportion of the above-mentioned drug in the above-mentioned drug prescription based on the drug information of the above-mentioned drugs.

In some feasible implementation manners, according to the average daily drug cost of each type of drug determined in step S12 above, the daily average drug cost threshold corresponding to the single-day prescription of the unit to be monitored can be determined, and the above-mentioned various Among the class of drugs, drugs whose average daily drug cost is greater than or equal to the above-mentioned daily average drug cost threshold are determined to be valuable drugs in the single-day prescription of the medical unit to be monitored. Here, the valuable drug refers to a drug whose daily drug cost per drug is higher than the daily drug cost per drug prescribed for a single day and that the daily drug cost per drug is greater than or equal to the threshold of the daily drug cost per drug. In other words, based on the average daily drug cost of each drug in a single-day prescription, the average daily drug cost of various drugs can be sorted in order from high to low, and then the average daily drug cost of single drug The top part (for example, 20%) of the medicines with the lowest average daily drug cost of the single drug is determined as the average daily drug cost threshold for the single drug. At this time, the average daily drug cost of each drug in this part (that is, 20%) of the drugs The drug cost is greater than or equal to the single drug daily average drug cost threshold, and then this part (ie 20%) of the drug can be determined as a valuable drug. For example, among all medicines prescribed in a single day, the average daily medicine cost of a single medicine is x yuan / day (that is, the threshold of the daily average medicine cost of a single medicine), for example, a medicine of 11 yuan / day is a valuable medicine. In other words, 20% of all medicines included in the single-day prescription of the medical unit to be monitored are medicines with an average daily drug cost of 11 yuan / day or more, and these medicines are valuable medicines.

In some feasible implementation manners, according to the drug information of the above-mentioned types of drugs, the total amount of drugs of all drugs in the above-mentioned drug prescription and the total amount of valuable drugs of the above-mentioned valuable drugs included in the above-mentioned drug prescription can be determined. The proportion of valuable drugs in the single-day prescription of the medical unit to be monitored can be determined based on the total amount of all the above drugs and the total amount of valuable drugs. Here, the ratio of precious drugs may be the ratio of the total amount of valuable drugs in a single-day prescription to the total price of all drugs prescribed in a single day, that is to say, the ratio of precious drugs satisfies the following formula (3):

Formula (3): Proportion of valuable drugs = total value of valuable drugs / total amount of drugs of all drugs.

In the above formula (3), the total value of valuable drugs is the cumulative value of the prices of various types of valuable drugs in a single-day prescription, where the price of each type of valuable drugs is the product of the quantity of such types of valuable drugs and the unit price of such types of valuable drugs. The total amount of medicines of all the above medicines is the cumulative value of the prices of various medicines in a single day prescription.

S14: Determine whether the medication used by the medical unit to be monitored exceeds the standard according to the target drug ratio and the target drug ratio threshold corresponding to the medical unit to be monitored.

In some feasible implementation manners, when drug monitoring is performed for different medical units, the evaluation index thresholds of the drug monitoring standards and / or drug evaluation standards of each medical unit may be preset. Wherein, the threshold of the assessment index may be a threshold of the proportion of valuable drugs, for example, the upper limit of the proportion of precious drugs, or the upper limit of the proportion of valuable drugs. For example, when drug monitoring is performed on the medical unit to be monitored, the upper limit of the proportion of valuable drugs corresponding to the medical unit to be monitored can be set based on the historical drug records of the medical unit to be monitored or the drug use policy, etc., and then based on the medical treatment to be monitored determined above The unit ’s proportion of valuable drugs, combined with the threshold of the assessment index corresponding to the medical unit to be monitored (ie, the upper limit of the proportion of precious drugs), determines whether the medical unit ’s medication exceeds the standard. In other words, it is whether the proportion of valuable drugs of the medical unit to be monitored is greater than its corresponding upper limit of the proportion of precious drugs. If the proportion of valuable drugs of the medical unit to be monitored is less than or equal to its corresponding daily average drug cost limit, it can be determined that the medical unit to be monitored meets the standard, that is, the medical unit to be monitored does not exceed the standard. If the proportion of precious medicines of the medical unit to be monitored is greater than the corresponding upper limit of the proportion of precious medicines, it can be determined that the medication of the medical unit to be monitored is exceeding the standard, that is, the medical cost of the medical unit to be monitored exceeds the standard.

S15. If the medication used by the medical unit to be monitored exceeds the standard, the risk of exceeding the drug cost of the medical unit to be monitored is controlled based on the target drug ratio of the medical unit to be monitored.

In some feasible implementation manners, when the medications of the medical unit to be monitored exceed the standard, for example, the proportion of precious medicines of the medical unit is greater than the threshold of the proportion of precious medicines, it can be determined that the proportion of the precious medicines of the medical unit to be monitored exceeds the medicine corresponding to the proportion of precious medicines Cost difference. Based on the above drug cost difference, the above-mentioned valuable drug proportion and / or the above drug cost difference can be publicized. Based on the published expensive drug proportion and / or drug cost difference, the physician of the medical unit to be monitored can control the prescription of the drug to avoid During the prescribing process, the doctor of the medical unit to be monitored randomly wastes medicine and other medical resources, and realizes the risk control of the drug cost exceeding the standard of the prescription of the medical unit to be monitored. Optionally, based on the above-mentioned proportion of valuable drugs and / or the above-mentioned difference in cost of drugs, 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 issued by the drug regulatory unit The medical unit's medication monitoring daily report will be publicized to control the medication of the medical unit to be monitored and its various doctors' prescriptions, to avoid the waste of medical resources caused by the continuous excess of the proportion of valuable drugs prescribed by the medical unit to be monitored, and to achieve the monitoring Risk control of over-medication in medical units. Optionally, based on the above-mentioned proportion of valuable drugs and / or the above-mentioned difference in cost of drugs, it can also be publicized on the information announcement interface of each department of the medical unit to be monitored, and / or opened by each physician of the medical unit to be monitored The publicity on the homepage of Fang Tools, etc., can be determined according to the actual application scenario, without limitation.

Based on the method provided by the embodiment of the present application, the operation of monitoring the medication of each medical unit is simple, which can improve the accuracy of monitoring the medication of the medical unit, improve the reliability of the monitoring of the medication of the medical unit, and thus can increase the cost of the drug prescription. The reliability of the over-standard risk control improves the controllability of the medication prescribed by the medical unit, thereby improving the effective utilization of medical resources and making it more applicable.

Example 2:

Referring to FIG. 2, FIG. 2 is another schematic flowchart of a method for controlling drug expense risk based on data processing provided by an embodiment of the present application. The drug cost risk control method based on data processing 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, and the method can be implemented through the implementation methods provided in the following steps S21 to S27 Instructions.

S21. Obtain the medication prescription of the medical unit to be monitored.

In some feasible implementation manners, 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.

Optionally, in some feasible implementation manners, 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. For convenience of description, 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.

Optionally, the single assessment cycle prescription of the medical unit may refer to all prescriptions issued in any assessment cycle of the medical unit more than one day, including but not limited to all prescriptions issued by all doctors in all departments of the hospital in a single assessment cycle All prescriptions, all prescriptions issued by all doctors in a department of the hospital in a single assessment cycle, or all prescriptions issued by a doctor in a department of the hospital in a single assessment cycle. Among them, 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. For the convenience of description, 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.

It can be understood that 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.

S22: Obtain the medicine information included in the above medicine prescription, and determine the average daily medicine cost of the medical unit to be monitored according to the above medicine information.

In some feasible implementation manners, for the specific implementation manner of determining the average daily drug cost of the medical unit to be monitored based on the drug information included in the medical prescription of the medical unit to be monitored may refer to the implementation manner provided in step S12 in the foregoing embodiment, I will not repeat them here.

Optionally, in some feasible implementation manners, 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. For the convenience of description, 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.

Optionally, the average daily drug cost for a single assessment cycle prescription can meet the following formula (4):

Formula (4): average daily drug cost = total periodical drug / total days of periodical drug use.

In the above formula (4), the total amount of periodic drugs can be the total amount of all drugs obtained by accumulating the total amount of all drugs included in all prescriptions in a single assessment cycle. The cumulative value of the number of days of use of each drug in all drugs included in the prescription.

Optionally, in some feasible implementations, based on the drug information included in the single assessment cycle prescription of the medical unit to be monitored, 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. In addition, based on the number of days of use of each drug included in the daily prescription of the medical unit to be monitored in a single assessment cycle, 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. Among them, 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. Based on the above-mentioned daily average daily drug cost and the total number of days of drug use of each medical unit to be monitored in a single evaluation cycle, the average daily drug cost of the medical unit to be monitored within a single evaluation cycle can be determined.

In some feasible implementation manners, 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.

Here, 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 (5):

Formula (5): average daily drug cost = accumulated value of average daily drug cost per day / cumulative value of total days of drug use.

Assuming that the single assessment cycle here is one week, the cumulative value of the average daily drug cost in the above formula (5) may be the cumulative average of the daily drug cost of each single-day prescription in the 7 single-day prescriptions within a week Value, the accumulated value of the total number of days of drug use in the above formula (5) may be the accumulated value of the total number of days of drug use of each single-day prescription in 7 single-day prescriptions within a week.

S23. Obtain the drug information of the various types of drugs included in the above medication prescriptions, and determine the average daily drug cost of each type of drugs based on the drug information of the above types of drugs.

In some feasible implementation manners, for the specific implementation manner of determining the average daily drug cost of a single medicine for various types of medicines of the medical unit to be monitored based on the drug information included in the medical prescription of the medical unit to be monitored, see step S12 in the above embodiment The implementation provided will not be repeated here.

Further, in some feasible implementations, based on the same principle of calculating the average daily drug cost of the above medical unit, the terminal device can also calculate each type of drug in all prescriptions within a single assessment cycle of the medical unit over multiple days The average daily drug cost of a single drug. Based on all the prescriptions within a single assessment cycle of the medical unit to be monitored, the drug information of all types of drugs included in all prescriptions can be obtained. The above drug information includes at least the drug amount and the number of days the drug is used. According to the drug information of all kinds of medicines in all prescriptions in the above single assessment cycle, determine the total amount of medicines of any kind of medicines and the total number of days of use of medicines of any kind of medicines in all prescriptions in the above single assessment period, according to any of the above The total amount of drugs for a class of drugs and the total number of days of use of any of the above-mentioned drugs determine the average daily drug cost per drug for any of the above-mentioned drugs to obtain the average daily drug cost for each drug of the above-mentioned types. Among them, the calculation of the average daily drug cost of a single drug of any of the above drugs can meet the following formula (6):

Formula (6): The average daily drug cost of a single drug = the total amount of drugs of any type of drug in a single evaluation period / the total number of days of use of drugs of any type of drug in a single evaluation period.

Among them, the total amount of any kind of drugs in the above formula (6) is the single-drug drug obtained by accumulating the price of a certain kind of drugs (in any category for convenience of description) of all the prescriptions of all drugs in a single assessment cycle The total price, the total number of days of use of any type of drug in the above single evaluation cycle is the cumulative value of the number of days of use of the drugs of this type among all prescriptions of all drugs within a single evaluation cycle.

Based on the implementation provided by the above formula (6), combined with the drug information of all types of drugs included in all prescriptions within a single assessment cycle of the unit to be monitored, each prescription in all prescriptions within a single assessment cycle of the medical unit to be monitored can be determined The average daily drug cost of a single drug of a class of drugs, and then based on the average daily drug cost of a single drug of the above-mentioned types of drugs, can determine the precious drugs in all prescriptions within a single evaluation cycle.

S24. Determine the target drug in the above-mentioned drug prescription based on the average daily drug cost of the above-mentioned drugs, and determine the target drug proportion of the above-mentioned drug in the above-mentioned drug prescription based on the drug information of the above-mentioned drugs.

In some feasible implementation manners, for the specific implementation manner of determining the average daily drug cost of a single medicine for various types of medicines of the medical unit to be monitored based on the drug information included in the medical prescription of the medical unit to be monitored, see step S13 in the above embodiment The implementation provided will not be repeated here.

Here, the proportion of valuable drugs may be the ratio of the total value of the valuable drugs in all prescriptions in a single evaluation period to the total price of all the drugs in all prescriptions in a single evaluation period, that is to say, the proportion of valuable drugs satisfies the following formula (7 ):

Formula (7): Proportion of valuable drugs = total value of valuable drugs / total amount of drugs of all drugs.

In the above formula (7), the total value of valuable drugs is the cumulative value of various types of valuable drugs in all prescriptions within a single evaluation period, where the price of each type of valuable drugs is the number of such valuable drugs and the value of such valuable drugs The product of unit prices. The total amount of medicines of all the above-mentioned medicines is the cumulative value of the prices of all kinds of medicines in all prescriptions in a single assessment period.

S25. Determine the upper limit of the target drug ratio of the medical unit to be monitored according to the unit attribute information of the medical unit to be monitored.

S26: Determine whether the medication used by the medical unit to be monitored exceeds the standard according to the target drug ratio of the medical unit to be monitored and the upper limit of the target drug ratio of the medical unit to be monitored determined above.

In some feasible implementation manners, for the specific implementation manner of determining whether the medication of the medical unit to be monitored exceeds the standard according to the ratio of the precious drugs of the medical unit to be monitored and the threshold value of the proportion of precious drugs corresponding to the medical unit to be monitored, refer to the steps in the above embodiment The implementation provided by S14 will not be repeated here.

Optionally, in some feasible implementations, when drug monitoring is performed for different medical units, 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 threshold value of the proportion of valuable drugs, such as the upper limit of the proportion of valuable drugs. Among them, 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. For example, for a medical unit associated with a city with a higher price or a medical unit associated with a higher drug cost caused by a drug supply channel, the upper limit of the proportion of valuable drugs can be set higher, namely The threshold of the assessment index of the corresponding medication monitoring standard can be set to a higher assessment index. For medical units associated with cities with lower prices or medical units associated with lower drug costs caused by drug supply channels, the upper limit of the proportion of valuable drugs can be set lower, that is, their corresponding The threshold of the assessment index of the monitoring standard of medication can be set to a lower assessment index. The specifics can be determined according to actual application scenarios, and no limitation is made here.

In some feasible implementation manners, based on the above-mentioned determined ratio of valuable drugs of the medical unit to be monitored, combined with the assessment index threshold determined based on the unit attribute information of the medical unit to be monitored (that is, the upper limit of the proportion of valuable drugs), the medical unit ’s Whether the medication exceeds the standard, in other words, whether the proportion of valuable drugs in the medical unit to be monitored is greater than the corresponding upper limit of the proportion of precious drugs. If the proportion of valuable drugs of the medical unit to be monitored is less than or equal to the upper limit of the corresponding proportion of precious drugs, it can be determined that the medication of the medical unit to be monitored does not exceed the standard, otherwise the medication of the medical unit is overstandard.

Optionally, in some feasible implementation manners, the drug monitoring of the medical unit to be monitored may also be comprehensively evaluated based on the proportion of precious drugs and the daily average drug cost of the medical unit to be monitored. For example, only when the proportion of valuable drugs and the average daily drug cost exceed the standard, the drug cost of the medical unit to be monitored exceeds the standard. Similarly, in some feasible implementations, when monitoring drug use for different medical units, the evaluation index thresholds of the drug evaluation standards of each medical unit can be set based on the characteristics of each medical unit, such as the upper limit of the daily average drug cost, Or the average daily drug cost threshold. 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 index thresholds for drug evaluation standards may vary. For example, for a medical unit associated with a city with a higher price or a medical unit associated with a higher drug cost caused by a drug supply channel, the upper limit of the average daily drug cost can be set higher, namely The threshold of the assessment index of the corresponding medication evaluation standard can be set to a higher assessment index and so on. Furthermore, it can be determined whether the medical standard of the medical unit exceeds the standard based on the daily drug cost of the medical unit to be monitored as described above, combined with the threshold of the assessment index corresponding to the medical unit. In other words, whether the average daily drug cost of the medical unit to be monitored is greater than or equal to its corresponding daily average drug cost threshold. Furthermore, when the average daily drug cost of the medical unit to be monitored exceeds the standard, and the proportion of valuable drugs also exceeds the standard, it is determined that the medical unit of the medical unit exceeds the standard, otherwise the medical unit to be monitored does not exceed the standard. The specifics can be determined according to actual application scenarios, and no limitation is made here.

S27. If the medication used by the medical unit to be monitored exceeds the standard, the risk of exceeding the drug cost of the medical unit to be monitored is controlled based on the target drug ratio of the medical unit to be monitored.

In some feasible embodiments, based on the proportion of valuable drugs of the medical unit to be monitored, the difference of the drug cost of the over-standard part of the medical unit to be monitored is publicized, so as to realize the risk control of the drug cost exceeding the standard of the medical unit to be monitored For the manner, refer to the implementation manner provided in step S15 in the foregoing embodiment, and details are not described herein again.

Optionally, in some feasible implementation manners, based on the above drug cost difference, the medical unit to be monitored may be rejected by receiving the medical cost reimbursement request or the drug cost claim request submitted by the medical unit to be monitored The medical expense reimbursement request or the pharmaceutical expense claim request realizes the punishment for the assessment standard of the proportion of valuable drugs of the medical unit to be monitored exceeding the standard, so as to control the drug cost risk of the medical unit. For example, when the proportion of valuable medicines on a certain day of the medical unit exceeds the standard, the medical unit may report back to the medical unit the cost of all prescription medicines on that day when receiving the medical expense reimbursement and / or request for that day. Reimbursement failed. In other words, when the ratio of valuable drugs on a certain day of the medical unit exceeds the standard, the terminal device can feed back the medical unit ’s day ’s The prescription drug cost refuses to be reimbursed or settled, and the medical unit can be prompted to self-control the proportion of precious drugs prescribed per day to realize the prescription risk control of the medical unit's drug cost exceeding the standard.

Optionally, in some feasible implementations, when the medical standard of the medical unit to be monitored exceeds the standard, for example, when the proportion of precious drugs prescribed by the medical unit in a single day is greater than the daily average drug cost threshold, the terminal device may calculate the value of the medical unit to be monitored The difference between the proportion of medicines and the threshold of the proportion of valuable medicines mentioned above. When the terminal device receives the request for reimbursement and / or claims for the medical expenses of the medical unit to be monitored, it can target the cost of the precious medicine corresponding to the difference between the proportion of the precious medicine of the medical unit to be monitored and the threshold value of the proportion of the precious medicine, Refuse to reimburse or settle claims for the difference in the cost of valuable drugs among the single-day prescriptions of the medical unit to be monitored to control the risk of prescriptions for the medical unit that exceeds the drug cost.

Optionally, in some feasible implementation manners, 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 When the proportion of precious medicines for prescriptions (such as a single-day prescription) is greater than the threshold of the proportion of valuable medicines, the terminal device can then be in the next assessment cycle (single On the second day of the day when the proportion of precious medicines exceeding the daily prescription exceeds the standard, for example, Tuesday), the report on the proportion of precious medicines exceeding the standard in the assessment cycle is transmitted to the medical unit to be monitored. Among them, the report on the proportion of excess valuable drugs is used to remind the medical unit to be monitored that the drug is exceeded within the evaluation period, and can remind the medical unit to be monitored if it is within the next evaluation cycle or multiple consecutive evaluation cycles within a specified time period If the proportion still exceeds the standard, the medical unit to be monitored will be punished for exceeding the proportion of valuable drugs. Among them, the above-mentioned punishment includes refusing to reimburse or settle claims for medicines that exceed the standard of the medical unit to be monitored, or refusing reimbursement or claims for the cost of expensive medicines that exceed the proportion of valuable drugs in the medical unit to be monitored. The above-mentioned report of excess proportion of valuable drugs is used to prompt the medical unit to be monitored to self-control the proportion of precious drugs to realize the risk control of the drug cost of the medical unit to be monitored exceeding the standard

Based on the method provided by the embodiment of the present application, 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 improves the medication controllability of the prescription of the medical unit and the effective utilization of medical resources, making it more applicable.

Example three:

Referring to FIG. 3, FIG. 3 is a schematic structural diagram of an embodiment of a drug cost risk control device based on data processing provided by an embodiment of the present application. The drug cost 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 used to obtain the medicine information of the medicines included in the medicine prescription obtained by the data obtaining unit 31, and determine the single-medium daily medicines of the medicines according to the medicine information of the medicines cost.

The above-mentioned drug information processing unit 32 is also used to determine the target drug in the above-mentioned drug prescription based on the average daily drug cost of the above-mentioned drugs, and to determine the above-mentioned target drug in the above-mentioned drug prescription based on the drug information of the above-mentioned drugs Target drug ratio.

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 target drug ratio determined by the drug information processing unit 32 and the target drug ratio 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 target drug ratio determined by the drug information processing unit, to perform a risk control of the drug cost of the monitored unit to exceed the standard.

In some feasible implementation manners, the data acquisition unit 31 is used to:

Obtain the data system access qualification of the medical unit to be monitored, and obtain the medication prescription of the medical unit to be monitored from the data system of the medical unit to be monitored based on the access qualification of the data system; and / or

Obtain the medical claim data provided by the medical unit to be monitored, and obtain the medication prescription of the medical unit to be monitored from the medical claim data;

Wherein, 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.

In some feasible implementation manners, the above-mentioned drug information processing unit 32 is used to:

Obtain the medicine information of all kinds of medicines included in all the medicine prescriptions obtained by the data acquisition unit, and the medicine information at least includes the medicine amount and the number of days the medicine is used;

According to the drug information of the above-mentioned types of drugs, determine the total amount of drugs of any type of drugs in the above-mentioned prescriptions and the total number of days of drug use of any of the above types of drugs;

Determine the average daily drug cost of a single drug of any of the above drugs based on the total amount of drugs of any of the above drugs and the total number of days of drug use of any of the above drugs to obtain the average daily drug cost of each of the above drugs;

Among them, the average daily drug cost of any of the above-mentioned drugs meets:

The average daily drug cost of a single drug = the total drug amount of any type of drug / the total number of days of drug use of any type of drug.

Determine the daily average single drug cost threshold corresponding to the above prescriptions according to the daily average drug cost of the above types of drugs, and make the average daily drug cost of the single drug among the above types of drugs greater than or equal to the above average daily drug cost The medicine with a threshold is determined as the target medicine in the above medicine prescription.

Determine the total drug amount of all drugs in the above drug prescription and the total target drug amount of the target drug included in the above drug prescription based on the drug information of the above types of drugs;

Determine the target drug proportion of the above drug prescription based on the total drug amount of all the above drugs and the above target drug amount;

Among them, the above target drug ratio meets:

Target drug ratio = total target drug / total drug for all drugs.

In some feasible implementation manners, the above-mentioned medicine information processing unit 32 is further used to:

Determine the upper limit of the target drug ratio of the medical unit to be monitored according to the unit attribute information of the to-be-monitored medical unit, and determine the upper limit of the target drug ratio to the target drug ratio threshold of the to-be-monitored medical unit;

Among them, 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.

In some feasible implementation manners, the above-mentioned medication risk control unit 34 is used to:

Publicize the drug cost difference corresponding to the target drug ratio and / or the target drug ratio exceeding the target drug ratio threshold, and prompt the medical unit to be monitored based on the announced target drug ratio and / or the drug cost difference Prescription drugs to achieve the risk control of exceeding the prescription drug cost; and / or

When receiving the drug expense reimbursement request corresponding to the target drug proportion and / or the drug cost difference, the drug expense reimbursement request is rejected to achieve the risk control of the drug prescription exceeding the standard.

In some feasible implementation manners, 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 medicine information processing unit 32 is also used for:

Obtain the drug information of each drug included in all the above drug prescriptions. The above drug information includes at least the drug amount and the number of days the drug is used;

Determine the total amount of all drugs included in all the above prescriptions based on the drug amount of each of the above drugs, and determine the total number of days of use of all the above drug prescriptions based on the number of days of use of each of the above drugs;

Determine the average daily drug cost of the medical unit to be monitored based on the total amount of the above drugs and the total number of days of use of the above drugs. .

Among them, the daily medical expenses of the above-mentioned medical units to be monitored meet:

Average daily drug cost = total drug / total days of drug use.

In some feasible implementation manners, 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 medicine information processing unit 32 is also used for:

Obtain any single-day medication prescription on any day within the above-mentioned single assessment cycle, and obtain the drug information of each drug included in any of the single-day medication prescriptions. The above-mentioned drug information includes at least the drug amount and the number of days of drug use;

Determine the average daily drug cost of the above-mentioned medical unit to be monitored based on the drug amount of each drug and the number of days of drug use included in any of the above single-day drug prescriptions;

Determine the average daily drug cost of the medical unit to be monitored based on the average daily drug cost and the total number of days of drug use of the medical unit to be monitored in each day of the single assessment cycle;

Among them, 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.

Determine the accumulated value of the average daily single-day drug cost of each day in the above single assessment cycle based on the daily average daily drug cost of each day in the above-mentioned single evaluation cycle, and determine the total number of days of drug use in each day of the above single evaluation period. Cumulative value of total days of drug use;

Determine the daily average drug cost of the medical unit to be monitored based on 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.

In some feasible implementation manners, the above-mentioned medication monitoring unit 33 is used to:

When the drug information processing unit determines that the target drug ratio of the medical unit to be monitored is less than or equal to the upper limit of the target drug ratio, it is determined that the drug used by the medical unit to be monitored does not exceed the standard;

When the target drug ratio of the medical unit to be monitored is greater than the upper limit of the target drug ratio, it is determined that the drug of the medical unit to be monitored exceeds the standard.

In some feasible implementation manners, the above-mentioned data processing-based drug expense risk control device may implement the implementation manners provided by the above steps in FIGS. 1 to 2 through various built-in functional modules. Optionally, the above drug cost risk control device based on data processing may be the terminal device described in each of the foregoing embodiments, and is not limited herein.

Based on the method provided by the embodiment of the present application, 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 also enhance the The operational flexibility of the unit's medication monitoring improves the medication controllability of the prescription of the medical unit and the effective utilization of medical resources, making it more applicable.

Example 4:

Referring to FIG. 4, FIG. 4 is a schematic structural diagram of an embodiment of a terminal device provided by an embodiment of the present application. As shown in FIG. 4, 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:

Obtain medication prescriptions for medical units to be monitored;

In some feasible implementation manners, the foregoing processor 401 is used 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.

Obtain the medicine information of all kinds of medicines included in all the above medicine prescriptions. The above medicine information at least includes the medicine amount and the number of days of medicine use;

Among them, the above target drug ratio meets:

Target drug ratio = total target drug / total drug for all drugs.

In some feasible implementation manners, the foregoing processor 401 is further used to:

The above processor 401 is also used for:

Determine the average daily drug cost of the medical unit to be monitored based on the total amount of the above drugs and the total number of days of use of the above drugs.

Average daily drug cost = total drug / total days of drug use.

The above processor 401 is also used for:

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. or

Optionally, the daily medical expenses of the medical unit to be monitored meet:

Average daily drug cost = total periodical drugs / total days of periodical drugs;

Among them, 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.

In some feasible implementation manners, the foregoing processor 401 is configured to:

When the target drug ratio of the medical unit to be monitored is less than or equal to the upper limit of the target drug ratio, it is determined that the drug used by the medical unit to be monitored does not exceed the standard;

In some feasible implementation manners, 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.

In some feasible implementation manners, 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. For details, refer to the implementation manners provided by the above steps And will not be repeated here.

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. For the provided drug cost risk control method based on data processing, please refer to the implementation provided in the above steps for details, which will not be repeated here.

The foregoing computer-readable storage medium may be the data processing-based drug cost risk control device provided in any of the foregoing embodiments or the internal storage unit of the foregoing terminal device, such as the hard disk or memory of the 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. Further, 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.

The above is only the specific implementation of this application, but the scope of protection of this application is not limited to this, any person skilled in the art can easily think of changes or replacements within the technical scope disclosed in this application. It should be covered by the scope of protection of this application. Therefore, the protection scope of the present application shall be subject to the protection scope of the claims.

Claims

A drug cost risk control method based on data processing, characterized in that the method includes:

Obtain medication prescriptions for medical units to be monitored;

Obtain the drug information of various types of drugs included in the medication prescription, and determine the average daily drug cost of each type of drugs based on the drug information of the types of drugs;

Determine the target drug in the prescription of the drug according to the average daily drug cost of each type of drug, and determine the target drug proportion of the target drug in the prescription of the drug according to the drug information of the type of drug;

Determine whether the medication used by the medical unit to be monitored exceeds the standard according to the target drug ratio and the target drug ratio threshold corresponding to the medical unit to be monitored;

If the medication used by the medical unit to be monitored exceeds the standard, the risk of exceeding the drug cost of the medical unit to be monitored is controlled based on the target drug ratio.
The method according to claim 1, wherein the obtaining the prescription of the medical unit to be monitored includes:

Acquiring the data system access qualification of the medical unit to be monitored, and obtaining the medication prescription of the medical unit to be monitored from the data system of the medical unit to be monitored based on the data system access qualification; and / or

Obtain medical claim data provided by the medical unit to be monitored, and obtain medication prescriptions of the medical unit to be monitored from the medical claim data;

Wherein, the medicine prescription of the medical unit to be monitored includes all the medicine prescriptions of the medical unit to be monitored in a single assessment cycle, and the period duration of the single assessment cycle includes a single day or multiple days.
The method according to claim 1 or 2, wherein the acquiring drug information of various types of drugs included in the medication prescription, and determining the drug types of the various types of drugs based on the drug information of the various types of drugs The average daily drug cost of a single drug includes:

Obtaining the medicine information of all kinds of medicines included in all the medicine prescriptions, the medicine information at least includes the medicine amount and the days of medicine use;

Determine the total amount of drugs of any type of drugs in the prescription and the total number of days of drug use of any type of drugs according to the drug information of the types of drugs;

Determine the average daily drug cost of a single drug of any one type of medicine according to the total amount of drugs of any one type of drugs and the total number of days of use of the drugs of any one type of drugs to obtain the average daily drug cost of a single type of drugs ;

Among them, the average daily drug cost of a single drug of any of the drugs meets:

The average daily drug cost of a single drug = the total drug amount of any type of drug / the total number of days of drug use of any type of drug.
The method according to claim 3, wherein the determining the target drug in the medication prescription based on the average daily drug cost of the various drugs includes:

The daily average daily drug cost threshold corresponding to the prescribed medication is determined according to the daily average daily drug cost of the various types of drugs, and the daily average daily drug cost of the single type of drugs in the various types of drugs is greater than or equal to the single drug The medicine with a daily average medicine cost threshold is determined as the target medicine in the medicine prescription.
The method according to claim 4, wherein the determining the target drug ratio of the target drug in the medication prescription according to the drug information of the various types of drugs includes:

Determine the total drug amount of all drugs in the drug prescription and the target drug amount of the target drug included in the drug prescription according to the drug information of the various types of drugs;

Determine the target drug proportion of the drug prescription based on the total drug amount of all the drugs and the target drug amount;

Among them, the target drug ratio meets:

Target drug ratio = total target drug / total drug for all drugs.
The method according to any one of claims 1-5, wherein the method further comprises:

Determining the upper limit of the target drug ratio of the medical unit to be monitored according to the unit attribute information of the medical unit to be monitored, and determining the upper limit of the target drug ratio to the target drug ratio threshold of the medical unit to be monitored;

Wherein, the unit attribute information of the medical unit to be monitored includes one or more of the unit type, the area where the unit is located, the city where the unit is located, the unit drug supply channel, and the number of patients per unit.
The method according to claim 6, wherein the risk control that the medical unit to be monitored exceeds the standard based on the target drug ratio includes:

Publicize the drug cost difference corresponding to the target drug ratio and / or the target drug ratio exceeding the target drug ratio threshold, and prompt the user based on the publicized target drug ratio and / or the drug cost difference The medical unit to be monitored controls the prescribing medication to achieve the risk control that the prescription drug cost exceeds the standard; and / or

When receiving the drug expense reimbursement request corresponding to the target drug proportion and / or the drug cost difference, the drug expense reimbursement request is rejected to realize the risk control of the drug prescription exceeding the standard of the drug prescription.
A drug cost risk control device based on data processing, characterized in that the device includes:

The data acquisition unit is used to acquire the medication prescription of the medical unit to be monitored;

The medicine information processing unit is used to obtain the medicine information of various medicines included in the medicine prescription obtained by the data obtaining unit, and determine the single medicine day of the medicines according to the medicine information of the various medicines Average drug cost;

The drug information processing unit is further used to determine the target drug in the medication prescription based on the average daily drug cost of the various drugs, and determine the target drug based on the drug information of the various drugs The target drug proportion in the prescribed medication;

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 target drug ratio determined by the drug information processing unit and the target drug ratio threshold corresponding to the medical unit to be monitored;

The medication risk control unit 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 target drug ratio determined by the drug information processing unit, to exceed the drug cost of the medical unit to be monitored Risk control.
The apparatus according to claim 8, wherein the data acquisition unit is configured to:

Acquiring the data system access qualification of the medical unit to be monitored, and obtaining the medication prescription of the medical unit to be monitored from the data system of the medical unit to be monitored based on the data system access qualification; and / or

Obtain medical claim data provided by the medical unit to be monitored, and obtain medication prescriptions of the medical unit to be monitored from the medical claim data;

Wherein, the medicine prescription of the medical unit to be monitored includes all the medicine prescriptions of the medical unit to be monitored in a single assessment cycle, and the period duration of the single assessment cycle includes a single day or multiple days.
The device according to claim 8 or 9, wherein the medicine information processing unit is used to:

Acquiring medicine information of all kinds of medicines included in the all medicine prescriptions obtained by the data obtaining unit, the medicine information including at least the medicine amount and the number of days of medicine use;

Determine the total amount of drugs of any type of drugs in the prescription and the total number of days of drug use of any type of drugs according to the drug information of the types of drugs;

Determine the average daily drug cost of a single drug of any one type of medicine according to the total amount of drugs of any one type of drugs and the total number of days of use of the drugs of any one type of drugs to obtain the average daily drug cost of a single type of drugs ;

Among them, the average daily drug cost of a single drug of any of the drugs meets:

The average daily drug cost of a single drug = the total drug amount of any type of drug / the total number of days of drug use of any type of drug.
The device according to claim 10, wherein the medicine information processing unit is configured to:

The daily average daily drug cost threshold corresponding to the prescribed medication is determined according to the daily average daily drug cost of the various types of drugs, and the daily average daily drug cost of the single type of drugs in the various types of drugs is greater than or equal to the single drug The medicine with a daily average medicine cost threshold is determined as the target medicine in the medicine prescription.
The device according to claim 11, wherein the medicine information processing unit is configured to:

Determine the total drug amount of all drugs in the drug prescription and the target drug amount of the target drug included in the drug prescription according to the drug information of the various types of drugs;

Determine the target drug proportion of the drug prescription based on the total drug amount of all the drugs and the target drug amount;

Among them, the target drug ratio meets:

Target drug ratio = total target drug / total drug for all drugs.
The device according to any one of claims 8-12, wherein the medicine information processing unit is further used to:

Determining the upper limit of the target drug ratio of the medical unit to be monitored according to the unit attribute information of the medical unit to be monitored, and determining the upper limit of the target drug ratio to the target drug ratio threshold of the medical unit to be monitored;

Wherein, the unit attribute information of the medical unit to be monitored includes one or more of the unit type, the area where the unit is located, the city where the unit is located, the unit drug supply channel, and the number of patients per unit.
The device according to claim 13, wherein the medication risk control unit is used to:

Publicize the drug cost difference corresponding to the target drug ratio and / or the target drug ratio exceeding the target drug ratio threshold, and prompt the user based on the publicized target drug ratio and / or the drug cost difference The medical unit to be monitored controls the prescribing medication to achieve the risk control that the prescription drug cost exceeds the standard; and / or

When receiving the drug expense reimbursement request corresponding to the target drug proportion and / or the drug cost difference, the drug expense reimbursement request is rejected to realize the risk control of the drug prescription exceeding the standard of the drug prescription.
A terminal device is characterized by comprising a processor and a memory, the processor and the memory are connected to each other, wherein the memory is used to store a computer program, the computer program includes program instructions, and the processor is It is configured to call the program instructions and perform the following operations:

Obtain medication prescriptions for medical units to be monitored;

Obtain the drug information of various types of drugs included in the medication prescription, and determine the average daily drug cost of each type of drugs based on the drug information of the types of drugs;

Determine the target drug in the prescription of the drug according to the average daily drug cost of each type of drug, and determine the target drug proportion of the target drug in the prescription of the drug according to the drug information of the type of drug;

Determine whether the medication used by the medical unit to be monitored exceeds the standard according to the target drug ratio and the target drug ratio threshold corresponding to the medical unit to be monitored;

If the medication used by the medical unit to be monitored exceeds the standard, the risk of exceeding the drug cost of the medical unit to be monitored is controlled based on the target drug ratio.
The terminal device according to claim 15, wherein the processor is configured to:

Obtaining the medicine information of all kinds of medicines included in all the medicine prescriptions, the medicine information at least includes the medicine amount and the days of medicine use;

Determine the total amount of drugs of any type of drugs in the prescription and the total number of days of drug use of any type of drugs according to the drug information of the types of drugs;

Determine the average daily drug cost of a single drug of any one type of medicine according to the total amount of drugs of any one type of drugs and the total number of days of use of the drugs of any one type of drugs to obtain the average daily drug cost of a single type of drugs ;

Among them, the average daily drug cost of a single drug of any of the drugs meets:

The average daily drug cost of a single drug = the total drug amount of any type of drug / the total number of days of drug use of any type of drug.
The terminal device according to claim 16, wherein the processor is configured to:

The daily average daily drug cost threshold corresponding to the prescribed medication is determined according to the daily average daily drug cost of the various types of drugs, and the daily average daily drug cost of the single type of drugs in the various types of drugs is greater than or equal to the single drug The medicine with a daily average medicine cost threshold is determined as the target medicine in the medicine prescription.
The terminal device according to claim 17, wherein the processor is configured to:

Determine the total drug amount of all drugs in the drug prescription and the target drug amount of the target drug included in the drug prescription according to the drug information of the various types of drugs;

Determine the target drug proportion of the drug prescription based on the total drug amount of all the drugs and the target drug amount;

Among them, the target drug ratio meets:

Target drug ratio = total target drug / total drug for all drugs.
The terminal device according to any one of claims 15 to 18, wherein the processor is used to:

Publicize the drug cost difference corresponding to the target drug ratio and / or the target drug ratio exceeding the target drug ratio threshold, and prompt the user based on the publicized target drug ratio and / or the drug cost difference The medical unit to be monitored controls the prescribing medication to achieve the risk control that the prescription drug cost exceeds the standard; and / or

When receiving the drug expense reimbursement request corresponding to the target drug proportion and / or the drug cost difference, the drug expense reimbursement request is rejected to realize the risk control of the drug prescription exceeding the standard of the drug prescription.
A computer-readable storage medium, characterized in that the computer-readable storage medium stores a computer program, and the computer program includes program instructions, which when executed by a processor cause the processor to execute as rights The method according to any one of claims 1 to 7.