開展DRGS對(duì)提升病案編碼員腫瘤疾病分類能力的對(duì)策

周英

[摘要] 當(dāng)前，大部分醫(yī)院已經(jīng)開始廣泛應(yīng)用疾病診斷相關(guān)組，且將國際疾病分類作為基礎(chǔ)前提。通過提升疾病分類質(zhì)量，能夠確保疾病診斷相關(guān)組的合理實(shí)施。國際疾病分類針對(duì)腫瘤分類做出了修訂，以此保障腫瘤患者的權(quán)益。疾病診斷相關(guān)組主要是聯(lián)合醫(yī)療資源使用與患者疾病情況，有效融合患者住院時(shí)間、疾病類型和治療費(fèi)用。所以腫瘤分類工作在醫(yī)院中具有重要作用，通過疾病診斷相關(guān)組可以加強(qiáng)腫瘤分類質(zhì)量，確保各項(xiàng)醫(yī)療工作順利開展。該次研究主要是基于疾病診斷相關(guān)組探討分析提升病案編碼員腫瘤疾病分類能力的對(duì)策，以此處理影響病案編碼員腫瘤疾病分類能力的各項(xiàng)因素，包括病案書寫不規(guī)范和編碼人員工作欠缺等方面，希望能夠?qū)ο嚓P(guān)人員起到參考性價(jià)值。

[關(guān)鍵詞] DRGS;病案編碼員;腫瘤疾病;分類對(duì)策

[中圖分類號(hào)] TN919.3+1，R828.3 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1672-5654（2020）03（a）-0037-03

[Abstract] At present， most hospitals have begun to widely use disease diagnosis related groups， and the international disease classification is used as the basic premise. By improving the quality of disease classification， it is possible to ensure the reasonable implementation of disease diagnosis related groups. The International Classification of Diseases has revised the classification of tumors to protect the rights of cancer patients. The disease diagnosis related group mainly combines the use of medical resources with the patient's disease status， and effectively integrates the patient's hospital stay， disease type and treatment cost. Therefore， the classification of tumors plays an important role in hospitals， and the quality of tumor classification can be strengthened through disease diagnosis related groups to ensure the smooth development of various medical tasks. This research is mainly based on disease diagnosis related groups to explore and analyze countermeasures to improve the classification ability of medical record coder's tumor disease， so as to deal with various factors that affect the medical record coder's classification ability of tumor disease， including irregular writing of medical records and lack of work of coding staff. On the other hand， which can have reference value to relevant personnel.

[Key words] DRGS; Medical record coder; Tumor disease; Classification strategy

國際疾病分類發(fā)展時(shí)間比較長，已經(jīng)成為國際上公認(rèn)的衛(wèi)生分類標(biāo)準(zhǔn)。當(dāng)前，國際疾病分類已經(jīng)經(jīng)過多次修訂。我國衛(wèi)生部門將國際疾病分類標(biāo)準(zhǔn)應(yīng)用到住院患者和手術(shù)患者中，以此反映出患者的病情和信息，還可以促進(jìn)醫(yī)院資源管理、決策以及資源投入等領(lǐng)域的發(fā)展[1]。疾病診斷相關(guān)組能夠有效結(jié)合患者疾病情況和醫(yī)療資源使用情況，能夠?qū)⒓膊☆愋汀⒆≡簳r(shí)間和治療費(fèi)用納入同一組，建立科學(xué)的醫(yī)療質(zhì)量評(píng)價(jià)機(jī)制，評(píng)價(jià)醫(yī)療服務(wù)態(tài)度質(zhì)量。

1 ?國際疾病分類標(biāo)準(zhǔn)制定原則分析