DRG sistēmā apmaksāto gadījumu kodēšanas procesa kvalitāte un tās ietekme uz saņemtā finansējuma apjomu SIA “Daugavpils reģionālā slimnīca
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
DRG apmaksas sistēma Latvijā ieviesta pirms vairākiem gadiem, bet tās efektivitāte un spēja pielāgoties vietējiem apstākļiem ir maz pētīta. Latvijā DRG finansēšanas modeļa realizācijā iesaistīti dažādi speciālisti, kas nereti slikti orientējas cits cita kompetenču jomā. Veidojas speciālistiem neskaidri sistēmas darbības posmi, kas rada daudzus jautājumus par DRG finansēšanas modeļa darbību un efektivitāti.
Maģistra darbā tiek pētīta veselības aprūpes finansēšanas modeļa, kas balstīts ar diagnozēm saistīto grupu sistēmā, īstenošana Daugavpils reģionālajā slimnīcā. Pētījuma mērķis ir izstrādāt priekšlikumus klīnisko datu kodēšanas kvalitātes uzlabošanai, orientējoties galvenokārt uz veselības aprūpes sistēmas taisnīgas finansēšanas mērķiem. Galvenie uzdevumi ir noskaidrot faktorus, kas ietekmē klīnisko datu atspoguļošanas kvalitāti un to, kā datu kvalitāte ietekmē saņemtā finansējuma apjomu Daugavpils reģionālajā slimnīcā.
Galvenie faktori, kas ietekmē datu kvalitāti, ir ārstu kompetences līmenis klīnisko datu kodēšanā pēc DRG principa, kā arī neuzmanības kļūdas un attieksme pret kodēšanas precizitāti, datu kontroliera kompetence un iejaukšanās klīnisko datu atspoguļošanā, datu ievades operatora nejaušības kļūdas.
Pētījumā secināts, ka, uzlabojot datu kodēšanas kvalitāti, ir iespējams palielināt finansējuma apjomu, ko Daugavpils reģionālā slimnīca saņem fiksētā DRG maksājuma veidā. Lai nodrošinātu veselības aprūpes sistēmas tuvināšanos taisnīgas finansēšanas mērķu sasniegšanai Daugavpils reģionālajā slimnīcā, būtu jāievieš uzlabojumi klīnisko datu kodēšanā. Pēc analizētās literatūras datiem, galvenās metodes, kas var uzlabot klīnisko datu kodēšanas kvalitāti, ir iekšējie un ārējie auditi un regulāras par kodēšanu atbildīgo personu apmācības.
Pētījuma rezultāti rosina diskusiju par nepieciešamību veikt sistēmiskus risinājumus problēmu novēršanai. Galvenie no tiem būtu valstiski organizēta personāla apmācība un būtiska NVD dienesta kapacitātes palielināšana, nodrošinot datu kvalitātes auditus un DRG grupētāja uzraudzību. Papildu svarīgi ilgtermiņa sistēmiski mērķi būtu vienotas izmaksu sistēmas vadlīniju ieviešana un DRG rādītāju sasaiste ar klīnisko rezultātu kvalitātes kritērijiem.
Autors: Iveta Liepa. Maģistra darbs: “DRG sistēmā apmaksāto gadījumu kodēšanas procesa kvalitāte un tās ietekme uz saņemtā finansējuma apjomu SIA “Daugavpils reģionālā slimnīca””. Zinātniskā vadītāja: lekt. Alina Dudele.
Rīga, RSU/RISEBA, 2022. 76 lapaspuses, 26 attēli, 16 tabulas, 2 pielikumi, 56 izmantotās literatūras un informācijas avoti.
DRG payment system was introduced in Latvia several years ago, yet its efficiency and potential for adjusting to the local conditions have been little studied. In Latvia, the implementation of DRG financing model involves various professionals who usually have poor understanding of one another’s sphere of competence. This leads to the formation of sections within the system functioning that are not clear for all professionals involved that gives rise to numerous questions concerning the functioning and efficiency of DRG financing model. The present Master thesis provides research on the implementation of DRG system model of health care financing at Daugavpils Regional Hospital. The aim of the research is elaborating suggestions for improving the quality of clinical data codification with the focus mostly on the goals of just financing within the health care system. Major research objectives are specifying the factors affecting the quality of clinical data reflection and the way data quality affects the amount of the received financing at Daugavpils Regional Hospital. Major factors that influence the quality of the data are the doctors’ competence level in coding clinical data according to DRG principle as well as their slips and attitude towards the precision of coding, the competence of the data controller, interference in reflection of the clinical data, and the slips of the data input operator. The research leads to a conclusion that, by improving the quality of data codifying, it is possible to enlarge the amount of financing received by Daugavpils Regional Hospital in the form of fixed DRG payment. To provide for approximation of the health care system to reaching just financing goals at Daugavpils Regional Hospital, improvement is needed in clinical data codifying. According to the analyzed literature data, major methods that may improve the quality of clinical data codification, are internal and external audits and regular training of persons responsible for codification. The research outcomes invite a discussion on the necessity to produce systemic solutions for eradicating the problems. Major solutions are centrally organized personnel training and considerable enlargement of the capacity of NHS guaranteeing data quality audits and the DRG grouper monitoring. Additional important long-term systemic goals are introduction of unified expenditure system guidelines and connecting DRG indicators with clinical result quality criteria. Author: Iveta Liepa. Master Thesis: “Quality of the process of codifying DRG payments and its impact on the amount of the received financing by “Daugavpils Regional Hospital ltd.”. Scientific Supervisor: lecturer Alina Dudele. Rīga, RSU/RISEBA, 2022. 76 pages, 26 figures, 16 tables, 2 appendix, 56 literature and information sources.
DRG payment system was introduced in Latvia several years ago, yet its efficiency and potential for adjusting to the local conditions have been little studied. In Latvia, the implementation of DRG financing model involves various professionals who usually have poor understanding of one another’s sphere of competence. This leads to the formation of sections within the system functioning that are not clear for all professionals involved that gives rise to numerous questions concerning the functioning and efficiency of DRG financing model. The present Master thesis provides research on the implementation of DRG system model of health care financing at Daugavpils Regional Hospital. The aim of the research is elaborating suggestions for improving the quality of clinical data codification with the focus mostly on the goals of just financing within the health care system. Major research objectives are specifying the factors affecting the quality of clinical data reflection and the way data quality affects the amount of the received financing at Daugavpils Regional Hospital. Major factors that influence the quality of the data are the doctors’ competence level in coding clinical data according to DRG principle as well as their slips and attitude towards the precision of coding, the competence of the data controller, interference in reflection of the clinical data, and the slips of the data input operator. The research leads to a conclusion that, by improving the quality of data codifying, it is possible to enlarge the amount of financing received by Daugavpils Regional Hospital in the form of fixed DRG payment. To provide for approximation of the health care system to reaching just financing goals at Daugavpils Regional Hospital, improvement is needed in clinical data codifying. According to the analyzed literature data, major methods that may improve the quality of clinical data codification, are internal and external audits and regular training of persons responsible for codification. The research outcomes invite a discussion on the necessity to produce systemic solutions for eradicating the problems. Major solutions are centrally organized personnel training and considerable enlargement of the capacity of NHS guaranteeing data quality audits and the DRG grouper monitoring. Additional important long-term systemic goals are introduction of unified expenditure system guidelines and connecting DRG indicators with clinical result quality criteria. Author: Iveta Liepa. Master Thesis: “Quality of the process of codifying DRG payments and its impact on the amount of the received financing by “Daugavpils Regional Hospital ltd.”. Scientific Supervisor: lecturer Alina Dudele. Rīga, RSU/RISEBA, 2022. 76 pages, 26 figures, 16 tables, 2 appendix, 56 literature and information sources.
Description
Veselības vadība
Health management
Veselības aprūpe
Health Care
Health management
Veselības aprūpe
Health Care
Keywords
DRG, kodēšanas procesa kvalitāte, Daugavpils reģionālā slimnīca, DRG, Quality of the process of codifying, DRG payments