CAJ | 학술논문

诊断相关组是美国医疗保险医院补偿系统预付费的依据,目的是将医院的病例组合与所需的资源和花费相联系.各组的定义与划分应有共同的组织系统或病因学,且有共同的临床特性又有相近的资源消耗.根据主要诊断、主要手术、重要的合并症和并发症、年龄(以17岁区别成年人和未成年人)、性别、新生儿体重等进行分组.按照美国第18版分组定义编制程序,对北京二级以上医院病案首页数据进行分组,根据分组情况、分组的合理性及各组的权重分析,采用美国的分组结构是可行的,但应根据我国情况进行适当的变更.
진단상관조시미국의료보험의원보상계통예부비적의거,목적시장의원적병례조합여소수적자원화화비상련계.각조적정의여화분응유공동적조직계통혹병인학,차유공동적림상특성우유상근적자원소모.근거주요진단、주요수술、중요적합병증화병발증、년령(이17세구별성년인화미성년인)、성별、신생인체중등진행분조.안조미국제18판분조정의편제정서,대북경이급이상의원병안수혈수거진행분조,근거분조정황、분조적합이성급각조적권중분석,채용미국적분조결구시가행적,단응근거아국정황진행괄당적변경.
Prospective payment rates based on diagnosis related groups (DRGs)have been established as the basis of Medicare' s hospital reimbursement system.The purpose of the DRGs is to relate a hospital's case mix to the resource demands and associated costs experienced.The patient characteristics included in the definition of each DRG relate to a common organ system or etiology,and each DRG should contain patients,who are similar from a clinical perspective,with a similar pattern of resource intensity.DRGs were divided by principle diagnosis,major surgery,major complication and/or comorbidity,age,sex,birth weight etc.Using a grouping software(version 18)by DRG definitions used in the United Stated,we encoded the hospital discharge data of all secondary and senior hospitals in Beijing.After analyzing the DRG grouping,as well as rationality and weighting of these DRG groups,we concluded that it was feasible to encode Chinese data using US DRG definitions with specific adjustments accommodating to relevant conditions in China.