Implementation of the diagnosis procedure combination in specific-function hospitals.
Implementation of the diagnosis procedure combination in specific-function hospitals.
复制标题
诊断流程组合在特定职能医院的实施。
DOI：
10.1272/jnms.71.217
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
A. Tokunaga
中科院分区：
文献类型：
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作者：
T. Kiyama;T. Tajiri;T. Yoshiyuki;N. Taniai;E. Uchida;A. Tokunaga
2003年，日本医科大学医院和其他81家特殊功能医院实施了诺贝尔医疗支付系统-诊断程序组合（DPC）。这一支付制度取决于住院时间、诊断和医疗程序，与现行的按件计酬制度不同。根据《国际疾病和有关健康问题统计分类》（ICD-10）定义的近2，500组DPC，每日支付额各不相同，手术等程序（现有支付系统的K和J代码）也各不相同。最重要的结果之一可能是住院时间的缩短，因为官方规定特殊功能医院的平均住院时间为14至30天，最长和最短平均住院时间之间的差异几乎是两倍。新的医疗支付系统应该刺激医院之间的竞争。为了缩短住院时间，我们为接受手术的患者制定了临床路径，如腹腔镜胆囊切除术、胃切除术和腹股沟疝手术，以及手术程序的临床方案，如经皮经鞘胆管引流术（PTCD）和经皮内镜胃造口术（PEG）。医疗保健正在经历一场充满挑战的转型，我们必须改善患者护理和临床实践。
A Nobel medical payment system, the Diagnosis Procedure Combination (DPC), was implemented in Nippon Medical School Hospital and 81 other specific-function hospitals in 2003. This payment system depends on the length of hospital stay and diagnosis and medical procedures, and differs from the existing payment system, which depends on a piece rate. The daily payment differs for among almost 2,500 groups of DPC defined by the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and procedures, such as operations (K and J codes of the existing payment system). One of the most important outcomes may be a decrease in lengths of hospital stay, because the range of mean lengths of stay in specific-function hospitals has been officially stated to be 14 to 30 days, and the difference between the longest and shortest mean is almost double. The new medical payment system should stimulate competition among hospitals. In order to decrease the length of stay, we developed clinical pathways for patients undergoing surgery, such as laparoscopic cholecystectomy, gastrectomy, and inguinal hernia operations, as well as clinical protocols for the surgical procedures, such as percutaneous transhepatic cholangiodrainage (PTCD) and percutaneous endoscopic gastrostomy (PEG). Health care is undergoing a challenging transition, and we must improve patient care and clinical practice.