DRG支付方式下基于人工智能合理用药专家系统创建医生处方行为治理模式及影响机制研究

提升医疗机构合理用药水平和有效使用医保资金，是国民经济和社会发展的迫切需要。规范医生处方行为是重要的管理措施之一。既往管理处方行为的效果不佳，皆因事后干预处方行为，没有解决干预的“及时性”，其实质是流程问题。如何解决处方行为干预的流程问题，是管理学的科学问题。据此提出科学假说：在DRG支付规则下，创新流程再造，构建医嘱实时审核流程；由人工智能合理用药专家系统自动审核；辅以药师人工复核的人机结合方式。三者相辅相成，构成有机整体，最终实现可复制的标准化流程和治理模式。课题组已建立了基于信息化辅助的药师实时处方审核模式和研发了《住院患者用药医嘱审核系统》。结合人因学开发人工智能合理用药专家系统，利用哈林顿模型构建医嘱实施审核流程，构建处方行为治理模式。设计自身前后对照研究，采用合理用药和经济学指标，评估治理模式的效果。应用扎根理论研究影响处方行为的机制。为医疗机构提供处方行为管理学方法和模式。

It is an urgent need for national economic and social development to improve the level of rational drug use and the effective use of limited medical insurance funds. Regulating doctors 'prescription behavior is one of the important management measures. The ineffective prescription management in the past is due to the post-intervention of prescription behavior, which fails to solve the "timeliness" of intervention. The essence is a process problem. How to solve the problem of prescription behavior intervention is a scientific problem in management science. Based on this, a scientific hypothesis was put forward: under DRG payment rules, innovative process reengineering was conducted to construct real-time review process of doctor's orders. Automatic review by artificial intelligence rational medication expert system. Pharmacists and machines work together to review prescriptions. These three parts are closely related, constituting an organic links aming to realize a replicable standardized process and governance model. The research group has successfully established the mode of real-time prescription review for pharmacists based on information-based assistance and developed the patented software " pre-audit system for medical orders in hospitalized ". This study intends to develop an artificial intelligence rational medication expert system with Human Factors Engineering. Based on the process reengineering Harrington model, the real-time review system of doctor’s orders is carried out and finally build the prescription behavior governance model. Design the before-after study, using rational drug use and economic outcomes to evaluate the effect of the governance model. Grounded theory is applied to study the mechanism of influencing doctors' prescribing behavior. In order to provide prescription behavior management methods and models for medical institutions.