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    Home > Active Ingredient News > Infection > The new version of the third-level hospital evaluation standards in DRG or into the core evaluation system

    The new version of the third-level hospital evaluation standards in DRG or into the core evaluation system

    • Last Update: 2021-01-04
    • Source: Internet
    • Author: User
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    On December 28, Chen Peng released the "Third-level Hospital Assessment Standard (2020 Edition)" (hereinafter referred to as the 2020 edition of the Standard).
    this is the first new standard version in nine years following the 2011 Release of the Third Level General Hospital Assessment Standard (2011 Edition) (hereinafter referred to as the 2011 Edition Standard).
    images from the National Health And Safety Commission's official artery network compared the 2020 version of the standard with the 2011 version of the standard.
    found that the 2020 version of DRG has a lot of ink, so to speak, DRG will become the next three-level hospital evaluation standards an important part! Focusing on the day-to-day, more objective, DRG into the 2020 version of the standard core evaluation standards in the 2020 version of the standard, the most important part of the modification is to divide all the content into three parts.
    , the second part is the medical service capacity and quality and safety monitoring data part, a total of 74 sections of 240 monitoring indicators, in the evaluation of the comprehensive score of the weight is not less than 60%, can be said to be the most important.
    images from the "three-level hospital evaluation standard (2020 edition)" compared to the 2011 version of the standard, the second part of the 2020 version of the standard mainly increased the hospital resource allocation, quality, safety, service, performance and other indicators monitoring and DRG evaluation, single-disease quality control and key medical technology and other daily monitoring data proportion, and a large number of applications of DRG evaluation system.
    no exaggeration to say that DRG is the core thread that runs through the second part of the 2020 edition.
    2020 standard medical service capacity indicators include the number of diseases admitted (ICD-10 four sub-items), the number of inpatient surgery (ICD-9-CM-3 four-bit sub-item number), DRG-DRGs group number, DRG-CMI, DRG time index and DRG cost index a total of six indicators.
    these indicators are directly related to DRG.
    Hospital quality indicators include the improvement of the annual national medical quality and safety objectives, the total mortality rate of patients in hospital, the hospital mortality rate of newborn patients, the hospitalization mortality rate of surgical patients, the rate of unanticided re-hospitalization of inpatients 0-31 days after discharge, the rate of unantic profitability of patients returning to the operating room within 48 hours/31 days after surgery, and the hospitalization mortality rate of 115 patients with low risk of ICD.
    these indicators are more or less associated with DRG.
    chapter VII of the 2011 edition of the standard also puts forward corresponding requirements for the hospital's medical service capacity.
    Such as the daily monitoring indicators of treatment quality include the number of surgical freezing and paraffin diagnosis compliance cases, malignant tumor preoperative diagnosis and postoperative pathological diagnosis compliance number, inpatient deaths and automatic discharge cases, inpatient surgery and death cases, hospital critical rescue cases and deaths, emergency department critical rescue cases and deaths, and neonatal patients hospital mortality.
    In the inpatient quality and safety monitoring indicators that can be directly compared to the standard DRG content of the 2020 edition, the 2011 edition focuses on the quality of results in the three categories of re-entry rate (re-hospitalization and re-surgery), mortality (hospitalization and postoperative death), and safety indicators (complications and patient safety), including Inpatient key diseases (total number of cases, number of deaths, number of re-hospitalizations within 2 weeks and 1 month, average number of hospitalization days and average hospitalization costs), inpatient key surgery (total number of cases, number of deaths, number of un anticipated re-operations after surgery, average number of hospitalization days and average hospitalization costs), anesthesia and hospitalization safety indicators.
    of the 2020 standard, the number of admitted diseases (ICD-10 four sub-targets), the number of inpatients (ICD-9-CM-3 four-bit sub-items), DRG-DRGs group three indicators represent the "breadth" of hospital medical services capacity.
    the number of DRG groups covered by these three indicators indicates that the more comprehensive the hospital technology is.
    assumes that a general hospital can cover more than 400 subgroups in that year, and that another hospital in the same area can cover more than 200, indicating that the latter's comprehensive service capacity is not as good as the former.
    DRG-CMI can measure the "depth" of overall medical services, i.e. the technical difficulty is high or low, the higher the difficulty of hospital medical services.
    assumes that the average weight of cases in a local hospital is 1, the average weight of A hospital under the same number of cases is 1.5, and B hospital is only 0.7.
    A hospital has a high level of technology and B hospital has a lower level of technology.
    DRG Time Index refers to the average time it takes a hospital to treat a group of patients, and the DRG Cost Index refers to the average cost of treating a group in a hospital.
    these two weight-adjusted indicators can measure the efficiency of hospitals.
    because DRG has very high requirements for data acquisition, the 2020 version of the standard also has a uniform provision for data acquisition standards.
    data collected by the National Medical Quality Management and Control Information Network (NCIS), the National Hospital Quality Monitoring System (HQMS) and relevant data collection systems at the provincial levels have uniform data requirements and standards.
    The ICD code used is based on the National Clinical Edition 2.0 of the Disease Classification and Code, which is commonly referred to as "Clinical Version ICD-10", and the surgical operation code used is the National Clinical Edition 2.0 of the Surgical Operation Classification Code, which is commonly referred to as "National ICD-9-CM3".
    , the 2011 version of the standard also provides for disease classification codes and surgical codes.
    the development of DRG in China has not yet formed a unified tone, the coding and DRG groupers used in different places are also very different.
    is that data availability was not good because there were no uniform and objective data collection sources and standards.
    , the evaluation of the 2011 version of the standard is mainly based on more general data as the evaluation criteria.
    , the 2020 version of the standard pays more attention to day-to-day quality management and performance than the 2011 version of the standard, but also has data indicators that can be based on, more objective.
    DRG will play a central role in it, and a good understanding and mastery of DRG as a tool will be key to whether a hospital can pass a Level 3 hospital review.
    addition to this significant change in DRG, there are some other significant improvements to the 2020 standard compared to the 2011 version of the standard.
    first of all, fully integrated into the new policy and medical reform requirements, reflecting the times.
    2020 version of the standard, on the basis of maintaining the continuity of the 2011 version of the standard, into the Basic Medical and Health Promotion Law, medical dispute prevention and treatment regulations, medical quality management measures, medical technology clinical application management measures, medical quality and safety core system points, and other laws, regulations, regulations and graded medical system construction, modern hospital management system and other reform requirements promulgated in recent years.
    the same time, in response to the current new crown epidemic, the 2020 version of the standard also added the new crown pneumonia epidemic normal prevention and control related requirements.
    In section III of the pre-requirements of Part I of the 2020 edition of the Standard, the following definitions are made for "safety management and major events": the occurrence of a level 1 medical accident that is defined as full responsibility or a major medical incident directly determined by the Health administration; Major hospital infections occur, resulting in serious consequences, major safety incidents that have been notified or punished due to major fires, radiation leakage, harmful gas leaks, etc., acts of underreporting or underreporting of major medical negligence, and large-scale medical data leakage or other major network security incidents, resulting in serious consequences.
    , the aforementioned qualitative and quantitative transformation by supervisors to enhance scientific nature.
    Through the introduction of a more scientific and objective DRG evaluation system, the 2020 version of the standard hopes to guide all places from on-site inspection, subjective qualitative, centralized inspection-based evaluation form to daily monitoring, objective indicators, on-site inspection, qualitative and quantitative combination of the evaluation work model.
    third is to sort out the integration and simplify the field review terms, improve the operability.
    2020 version of the standard on-site inspection part of a total of 24 sections 183, compared to the 2011 version of the standard 66 sections 354 have been greatly compressed.
    On the one hand, comprehensively combing and integrating the duplicate clauses in the original standard to improve work efficiency, on the other hand, the original standard is not very operational, or can be used for daily data monitoring instead of site inspection provisions have been eliminated or adjusted to improve the operability of the standard.
    , the 2020 version of the standard pay more attention to learn from international and domestic advanced concepts and experience, reflecting compatibility.
    it fully draws on the working methods and standards of some international hospital evaluation institutions, and adopts the good experience and practices of some provinces and cities in China, and is more compatible and compatible with the advanced concept of international and domestic evaluation and management.
    written in the end as a management tool, DRG has both "control fee" and "quality management" two uses.
    fact, the first-generation DRG system developed by Yale University in the United States is a quality management tool designed to help clinicians and hospitals monitor service quality and utilization.
    in the 2020 version of the standard, DRG was raised to the status of a core tool.
    means that all level 3 hospitals in our country, as well as level 2 hospitals that want to upgrade to level 3 hospitals, need to become familiar with and promote the application of DRG tools in hospitals as soon as possible in the next time.
    images come from the official website of the National Health Insurance Administration, which is pushing FORS-DRG and DIP on the payment side.
    the 2020 version of the standard for all third-tier hospitals in the country, no exceptions were noted.
    means that even level 3 hospitals in DIP pilot cities still need to use DRG tools on the evaluation criteria, considering that the Medicare version of the code enables a 100% mapping of the health care board version of the code.
    , it also reflects the future direction of DIP and DRG from the side.
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