| 摘要: |
| 目的:探讨病案首页编码正确率与临床路径一致性的匹配情况,并在疾病诊断相关组(DRG) 结算场景下识别典型错误
模式及高风险组合,为医院精细化管理及儿科药学服务提供参考。方法:选取某三甲儿童医院2024 年每月1 日-5 日出院的儿
科住院病案共13 754 份,经质控系统筛查及人工复核后,按结算方式等分组分析,并采用Apriori 算法进行关联规则挖掘和网络
可视化。结果:总体编码正确率为87. 85%。DRG 病案错误率高于非DRG 病案( 13. 28% vs. 10. 18%, χ2 = 31. 25,df = 1,P <
0. 001)。错误主要集中于合并编码未使用、诊断不明及年龄冲突等。共挖掘出12 条强关联规则,最高提升度为2. 46,其中“路
径偏离”“DRG 结算”“新生儿黄疸”等为关键节点。结论:编码错误具有明显规则性和结构性,与DRG 结算、路径偏离及特定诊
疗行为密切相关。加强路径管理、编码培训及多部门协同干预,有助于提升编码质量,并为儿童药物治疗信息识别及儿科药学
精细化管理提供支持。 |
| 关键词: 病案首页 编码质量 临床路径 疾病诊断相关组结算 儿科药学 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2026.07.006 |
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| 基金项目: |
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| Pediatric Refined Management Based on Coding Accuracy and Clinical Pathway Consistency: AssociationRule Analysis Under the Diagnosis-Related Groups Payment System |
| Xu Dandan, Shi Chujin |
| ((Children’s Hospital of Soochow University, Jiangsu Suzhou 215000, China)) |
| Abstract: |
| Objective: To investigate the alignment between coding accuracy of medical record home pages and clinical pathway
consistency, and to identify typical error patterns and high-risk combinations under the diagnosis-related groups (DRG) payment system,
so as to provide reference for refined hospital management and pediatric pharmaceutical services. Methods: A total of 13,754 pediatric
discharge records from a grade Ⅲ, level A hospital (sampled from the 1st to 5th of each month in 2024) were included. Following
quality-control system screening and manual verification, cases were grouped by settlement methods and other variables. Association rule
mining based on the Apriori algorithm and network visualization were applied to identify patterns of coding errors. Results: The overall
coding accuracy rate was 87. 85%. The error rate in DRG cases was significantly higher than that in non-DRG cases (13. 28% vs.
10. 18%, χ2 =31. 25, df=1, P<0. 001). Coding errors predominantly involved the unused combination codes, ambiguous diagnoses,
and age-related conflicts. Twelve strong association rules were identified, with a maximum lift value of 2. 46. Key network nodes
included “pathway deviation” “DRG settlement” “neonatal jaundice”. Conclusion: Coding errors exhibit distinct regularity and
structural characteristics, which are closely associated with DRG settlement, pathway deviation, and specific clinical practices.
Strengthening pathway management, coding training, and multidisciplinary collaborative intervention can effectively improve coding
quality and provide support for pediatric pharmacotherapy information identification and refined pharmaceutical management. |
| Key words: medical record home page coding quality clinical pathway diagnosis-related groups payment system pediatric pharmacy |
