Clinical pathway monitoring method and system based on DRG / DIP payment mode

Abstract

The application discloses a kind of clinical pathway monitoring method and system under the payment mode based on DRG / DIP, its method includes: determining the disease type of target patient, based on disease type, medical insurance version clinical pathway form is formulated to target patient;Determine the diagnosis and treatment project coefficient of each clinical pathway in medical insurance version clinical pathway form by historical treatment data, and medical insurance version clinical pathway form is optimized according to diagnosis and treatment project coefficient;Obtain the relevant diagnosis and treatment opinions of professional physician to the optimized medical insurance version clinical pathway form, and determine the final implementation clinical pathway according to relevant diagnosis and treatment opinions;The path progress monitoring index, path quality monitoring index and path cost monitoring index of final implementation clinical pathway are acquired, and the medical process of target patient is monitored according to it. Both medical insurance cost index and clinical pathway management double-index system monitoring are created, which assist hospital to control unreasonable growth of medical cost, and also ensure medical quality.

Description

Technical Field

[0001] This invention relates to the field of medical quality management technology, and in particular to a clinical pathway monitoring method based on the DRG / DIP payment model. Background Technology

[0002] Currently, with the deepening of my country's medical security system reform, Diagnosis Related Groups (DRG) and Disease-Based Value (DIP) payment models have become the mainstream medical insurance payment methods. The implementation of these two payment models has presented new challenges to hospital clinical pathway management. Traditional clinical pathway monitoring methods under the fee-for-service model are no longer adequate for the refined management needs of a prepayment environment.1 Current clinical pathway management under the DRG / DIP payment model faces technical bottlenecks. Existing clinical pathway monitoring systems lack a dual-dimensional dynamic evaluation mechanism for medical quality and cost consumption, making it difficult to achieve the organic unity of "cost control" and "quality improvement." Summary of the Invention

[0003] To address the aforementioned problems, this invention provides a clinical pathway monitoring method and system based on the DRG / DIP payment model. This addresses the shortcomings of existing clinical pathway monitoring systems mentioned in the background art, which lack a dual-dimensional dynamic evaluation mechanism for medical quality and cost consumption. This makes it difficult to achieve the organic unity of "cost control" and "quality improvement," thereby reducing medical quality and diagnostic efficiency, causing unnecessary medical expenses for patients, and lowering their experience.

[0004] A clinical pathway monitoring method based on the DRG / DIP payment model includes the following steps:

[0005] Determine the disease type of the target patients and develop a medical insurance version of the clinical pathway form for the target patients based on the disease type;

[0006] The coefficients of treatment items for each clinical pathway in the medical insurance version of the clinical pathway form are determined by using historical treatment data, and the medical insurance version of the clinical pathway form is optimized based on the coefficients of treatment items.

[0007] Obtain relevant medical opinions from professional physicians regarding the optimized medical insurance version of the clinical pathway form, and determine the final clinical pathway to be implemented based on these opinions;

[0008] Obtain the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators for the final implementation of the clinical pathway, and monitor the medical process of the target patients based on the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators.

[0009] Preferably, determining the disease type of the target patient and developing a medical insurance version of the clinical pathway form for the target patient based on the disease type includes:

[0010] Obtain the medical records of the target patients, determine the disease type of the target patients based on the medical records, and determine the clinical treatment methods based on the disease type;

[0011] Determine the treatment resources corresponding to the treatment methods for clinical symptoms, determine the relevant departments based on the treatment resources, and determine clinical pathways for multiple diseases based on the relevant departments.

[0012] Obtain the DRG payment standard for each disease clinical pathway, and develop a medical insurance version of the clinical pathway form for the target patients based on the DRG payment standard.

[0013] Preferably, the step of determining the treatment item coefficients for each clinical pathway in the medical insurance version of the clinical pathway form through historical treatment data, and optimizing the medical insurance version of the clinical pathway form based on the treatment item coefficients, includes:

[0014] Based on the medical insurance version of the clinical pathway form, multiple treatment items are identified, the cost structure of each treatment item is obtained, and multiple cost units are defined based on the cost structure.

[0015] Collect historical treatment data for each diagnostic and treatment item, and determine the historical treatment cost data for each diagnostic and treatment item based on the historical treatment data;

[0016] Frequency statistics were performed on multiple cost units using historical data on medical expenses, and the coefficients of medical items for each clinical pathway in the medical insurance version of the clinical pathway form were determined based on the statistical results.

[0017] Based on the coefficient of the clinical pathway, the first medical item with a value greater than or equal to a preset threshold is selected and designated as a mandatory medical item, while the second medical item with a value less than the preset threshold is designated as a non-mandatory medical item. The medical insurance version of the clinical pathway form is then optimized based on the classification results.

[0018] Preferably, obtaining relevant medical opinions from professional physicians regarding the optimized medical insurance version of the clinical pathway form, and determining the final implementation of the clinical pathway based on these opinions, includes:

[0019] Upload the optimized medical insurance version of the clinical pathway form to the professional physician's terminal and obtain relevant diagnosis and treatment opinions from the terminal;

[0020] Based on relevant medical opinions, determine the necessary and non-necessary medical procedures, and obtain the cost control rules for each of the necessary and non-necessary medical procedures.

[0021] Based on cost control rules, multiple combinations of medical items are determined for each price range, and the expected outcomes of each combination of medical items are obtained from the physicians.

[0022] Select target combination medical projects based on the expected outcomes, and determine the final clinical pathway based on the target combination medical projects.

[0023] Preferably, the step of obtaining the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators for the final implementation of the clinical pathway, and monitoring the medical process of the target patient based on the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators, includes:

[0024] Determine the reference indicators for enrollment rate, completion rate, and cost for the final implementation of the clinical pathway;

[0025] Based on the reference indicators of enrollment rate, completion rate, and cost, obtain the final clinical pathway implementation monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators.

[0026] The monitoring objects and monitoring processes are determined based on the path progress monitoring indicators, path quality monitoring indicators, and path cost monitoring indicators.

[0027] Data monitoring is performed on the monitored objects according to the monitoring process to achieve monitoring of the medical process of the target patients.

[0028] Preferably, the step of determining the treatment resources corresponding to the clinical disease treatment methods, determining the diagnosis-related departments based on the treatment resources, and determining multiple disease clinical pathways based on the diagnosis-related departments include:

[0029] The clinical disease treatment methods are broken down to determine the corresponding required drug resources, equipment resources, human resources and space resources;

[0030] Drug resources, equipment resources, human resources, and space resources are categorized as treatment resources, and multiple resource types of treatment resources are identified.

[0031] Match diagnostic-related departments based on resource type, and determine the leading and collaborating departments within the diagnostic-related departments, as well as the collaborative working mechanism between them;

[0032] Diagnostic and treatment process parameters are determined based on the leading and collaborating departments and their collaborative working mechanism. Clinical pathways for multiple diseases are then determined based on these parameters and rehabilitation indicators.

[0033] Preferably, the step of determining multiple treatment items based on the medical insurance version of the clinical pathway form, obtaining the cost structure of each treatment item, and defining multiple cost units based on the cost structure includes:

[0034] The medical insurance version of the clinical pathway form is broken down into multiple treatment items according to the timeline, and the item attributes of each medical item are determined. The item attributes include: mandatory items and optional items.

[0035] Determine each necessary medical procedure based on the project attributes, obtain the fee details for the necessary medical procedures, and determine the details of direct medical expenses and indirect medical expenses based on the fee details;

[0036] The cost structure for each necessary medical procedure is determined based on the details of direct and indirect medical expenses.

[0037] Based on the cost structure, multiple definition dimensions are determined, and multiple cost units for necessary medical procedures are defined through multiple positioning dimensions. The definition dimensions include: cost type, cost nature, and cost stage.

[0038] Preferably, after obtaining the medical insurance version of the clinical pathway form, it also includes:

[0039] Obtain historical treatment information of target patients based on disease type, determine medical data of target patients based on historical treatment information, and determine overall medical concepts for target patients based on medical data;

[0040] Based on the overall medical concept, determine the diagnostic and treatment decision factors for the target patient, and then determine the medical field based on the diagnostic and treatment decision factors;

[0041] Acquire clinical rules in the medical field, determine multiple diagnostic and treatment reference features for target patients based on clinical rules, and determine the key information elements included in the medical insurance version of the clinical pathway form based on the diagnostic and treatment reference features through a preset medical knowledge model.

[0042] Obtain mapping indicators for key information elements, and determine the key and non-key treatment items in the medical insurance version of the clinical pathway form based on the mapping indicators;

[0043] Determine the medical correlation parameters between the excluded treatment items and the key treatment items, and determine the parallel binding relationship between the excluded treatment items and the key treatment items based on the medical correlation parameters;

[0044] Based on the parallel and bundled nature of the clinical pathway form for medical insurance, determine the treatment items to be added and obtain the target treatment stage of the treatment items to be added.

[0045] Obtain the phase goals for the target treatment phase, determine the core treatment project group based on the phase goals, and confirm whether the core treatment project group includes any treatment projects to be added.

[0046] If yes, add the treatment items to be added to the medical insurance version of the clinical pathway form to generate a new medical insurance version of the clinical pathway form; otherwise, confirm that no treatment items need to be added.

[0047] An initial sequence of treatment nodes is generated based on the new medical insurance version of the clinical pathway form by using a pre-set comprehensive treatment information model.

[0048] A dynamic adjustment mechanism is generated based on the initial treatment node sequence and the appointment strategy for each treatment item. This mechanism is used to adjust the new medical insurance version of the clinical pathway form in real time.

[0049] Preferably, after determining clinical pathways for multiple diseases based on the relevant diagnostic departments, it also includes:

[0050] Determine the resource type corresponding to each disease clinical pathway, determine the medical resource usage level based on the resource type, and determine the medical resource occupancy cost index for each disease clinical pathway based on the medical resource usage level;

[0051] Obtain the frequency of single operations and the frequency of multiple collaborative operations for each disease's clinical pathway, and determine the operational complexity index of each disease's clinical pathway based on the frequency of single operations and the frequency of multiple collaborative operations.

[0052] Obtain the human resource allocation parameters for each disease's clinical pathway, and determine the human resource cost index for each disease's clinical pathway based on the human resource allocation parameters and collaborative operation process parameters;

[0053] The recommended fit of each disease clinical pathway is calculated based on the human cost index, operational complexity index, and medical resource occupation cost index of each disease clinical pathway.

[0054] Based on the recommended fit of each disease clinical pathway, the first disease clinical pathway with a value greater than or equal to the preset threshold is selected, and the second disease clinical pathway with a value less than the preset threshold is removed.

[0055] The clinical pathway for the first disease will be used as a reference clinical pathway for the medical insurance version of the clinical pathway form for the target patients.

[0056] A clinical pathway monitoring system based on the DRG / DIP payment model, the system comprising:

[0057] The module is used to determine the disease type of the target patient and to develop a medical insurance version of the clinical pathway form for the target patient based on the disease type.

[0058] The optimization module is used to determine the treatment item coefficients of each clinical pathway in the medical insurance version of the clinical pathway form through historical treatment data, and optimize the medical insurance version of the clinical pathway form based on the treatment item coefficients.

[0059] The determination module is used to obtain relevant medical opinions from professional physicians on the optimized medical insurance version of the clinical pathway form, and to determine the final clinical pathway to be implemented based on the relevant medical opinions.

[0060] The monitoring module is used to acquire the progress monitoring indicators, quality monitoring indicators, and cost monitoring indicators of the final clinical pathway, and to monitor the medical process of the target patient based on these indicators.

[0061] Other features and advantages of the invention will be set forth in the following description, and will be apparent in part from the description, or may be learned by practicing the invention. The objects and other advantages of the invention may be realized and obtained by means of the structures particularly pointed out in the written description and the accompanying drawings.

[0062] The technical solution of the present invention will be further described in detail below with reference to the accompanying drawings and embodiments. Attached Figure Description

[0063] The accompanying drawings are provided to further illustrate the invention and form part of the specification. They are used together with the embodiments of the invention to explain the invention and do not constitute a limitation thereof.

[0064] Figure 1 This invention provides a flowchart of a clinical pathway monitoring method based on the DRG / DIP payment model.

[0065] Figure 2 This is another workflow diagram of a clinical pathway monitoring method based on the DRG / DIP payment model provided by the present invention;

[0066] Figure 3 This is another flowchart of a clinical pathway monitoring method based on the DRG / DIP payment model provided by the present invention;

[0067] Figure 4 This is a schematic diagram of the structure of a clinical pathway monitoring system based on the DRG / DIP payment model provided by the present invention. Detailed Implementation

[0068] Exemplary embodiments will now be described in detail, examples of which are illustrated in the accompanying drawings. When the following description relates to the drawings, unless otherwise indicated, the same numerals in different drawings denote the same or similar elements. The embodiments described in the following exemplary embodiments do not represent all embodiments consistent with this disclosure. Rather, they are merely examples of apparatuses and methods consistent with some aspects of this disclosure as detailed in the appended claims.

[0069] Currently, with the deepening of my country's medical security system reform, Diagnosis Related Groups (DRG) and Disease-Based Value (DIP) payment models have become the mainstream medical insurance payment methods. The implementation of these two payment models presents new challenges to hospital clinical pathway management. Traditional clinical pathway monitoring methods under the fee-for-service model are no longer adequate for the refined management needs of a prepayment environment.1 Current clinical pathway management under the DRG / DIP payment model faces the following technical bottlenecks: Existing clinical pathway monitoring systems lack a dual-dimensional dynamic evaluation mechanism for medical quality and cost consumption, making it difficult to achieve the organic unity of "cost control" and "quality improvement." To address these issues, this embodiment discloses a clinical pathway monitoring method based on the DRG / DIP payment model.

[0070] A clinical pathway monitoring method based on the DRG / DIP payment model, such as Figure 1 As shown, it includes the following steps:

[0071] Step S101: Determine the disease type of the target patient and develop a medical insurance version of the clinical pathway form for the target patient based on the disease type;

[0072] Step S102: Determine the treatment item coefficients of each clinical pathway in the medical insurance version of the clinical pathway form through historical treatment data, and optimize the medical insurance version of the clinical pathway form based on the treatment item coefficients.

[0073] Step S103: Obtain relevant medical opinions from professional physicians regarding the optimized medical insurance version of the clinical pathway form, and determine the final clinical pathway to be implemented based on the relevant medical opinions;

[0074] Step S104: Obtain the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators for the final clinical pathway implementation, and monitor the medical process of the target patient based on the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators.

[0075] The working principle of the above technical solution is as follows: First, determine the disease type of the target patient; second, develop a medical insurance version of the clinical pathway form for the target patient based on the disease type; third, determine the treatment item coefficients for each clinical pathway in the medical insurance version of the clinical pathway form using historical treatment data; fourth, optimize the medical insurance version of the clinical pathway form based on the treatment item coefficients; fifth, obtain relevant treatment opinions from professional physicians on the optimized medical insurance version of the clinical pathway form; sixth, determine the final clinical pathway to be implemented based on the relevant treatment opinions; and seventh, obtain pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators for the final implemented clinical pathway, and monitor the medical process of the target patient based on these indicators.

[0076] The beneficial effects of the above technical solution are as follows: By determining the treatment item coefficients of each clinical pathway, the treatment items are objectively and reasonably assessed for their applicability, thereby optimizing the medical insurance version of the clinical pathway form and finally having experts review and determine the final clinical pathway to be implemented. This not only creates a dual-indicator monitoring system of medical insurance cost indicators and clinical pathway management, assisting hospitals in controlling unreasonable increases in medical costs, but also ensures medical quality, improves treatment efficiency and patient experience. It solves the problem mentioned in the existing technology that the existing clinical pathway monitoring system lacks a dual-dimensional dynamic evaluation mechanism for medical quality and cost consumption, making it difficult to achieve the organic unity of "cost control" and "quality improvement", reducing medical quality and treatment efficiency, causing unnecessary medical consumption for patients, and reducing patient experience.

[0077] In one embodiment, determining the disease type of the target patient and developing a medical insurance version of the clinical pathway form for the target patient based on the disease type includes:

[0078] Obtain the medical records of the target patients, determine the disease type of the target patients based on the medical records, and determine the clinical treatment methods based on the disease type;

[0079] Determine the treatment resources corresponding to the treatment methods for clinical symptoms, determine the relevant departments based on the treatment resources, and determine clinical pathways for multiple diseases based on the relevant departments.

[0080] Obtain the DRG payment standard for each disease clinical pathway, and develop a medical insurance version of the clinical pathway form for the target patients based on the DRG payment standard.

[0081] The beneficial effects of the above technical solution are as follows: by determining the clinical disease treatment methods and corresponding treatment resources based on the medical records of the target patients, it is possible to ensure that the patients receive the most targeted treatment and improve the treatment effect. Furthermore, by determining clinical pathways and DRG payment standards for multiple diseases based on treatment resources and developing a medical insurance version of the clinical pathway form for the target patients, it is possible to optimize the allocation of medical resources and reduce treatment costs.

[0082] In one embodiment, determining the treatment item coefficients for each clinical pathway in the medical insurance version of the clinical pathway form using historical treatment data, and optimizing the medical insurance version of the clinical pathway form based on the treatment item coefficients, includes:

[0083] Based on the medical insurance version of the clinical pathway form, multiple treatment items are identified, the cost structure of each treatment item is obtained, and multiple cost units are defined based on the cost structure.

[0084] Collect historical treatment data for each diagnostic and treatment item, and determine the historical treatment cost data for each diagnostic and treatment item based on the historical treatment data;

[0085] Frequency statistics were performed on multiple cost units using historical data on medical expenses, and the coefficients of medical items for each clinical pathway in the medical insurance version of the clinical pathway form were determined based on the statistical results.

[0086] Based on the coefficient of the clinical pathway, the first medical item with a value greater than or equal to a preset threshold is selected and designated as a mandatory medical item, while the second medical item with a value less than the preset threshold is designated as a non-mandatory medical item. The medical insurance version of the clinical pathway form is then optimized based on the classification results.

[0087] The beneficial effects of the above technical solution are as follows: Based on the medical insurance version of the clinical pathway form, multiple treatment items and historical treatment data are determined. Based on the historical treatment data, historical data of treatment costs for each treatment item are determined, and frequency statistics are performed on multiple cost units to identify essential and non-essential treatment items. This allows for the accurate identification of essential items. For non-essential treatment items, their usage scope and conditions are rationally planned based on their frequency of use and cost, avoiding resource waste. Furthermore, optimizing the medical insurance version of the clinical pathway form can better adapt to the DRG / DIP payment reform and reasonably control the cost ratio by adjusting the disease cost structure.

[0088] In one embodiment, such as Figure 2 As shown, obtaining relevant medical opinions from professional physicians regarding the optimized medical insurance version of the clinical pathway form, and determining the final implementation of the clinical pathway based on these opinions, includes:

[0089] Step S201: Upload the optimized medical insurance version of the clinical pathway form to the professional physician terminal and obtain relevant diagnosis and treatment opinions from the terminal;

[0090] Step S202: Determine the necessary and unnecessary medical procedures based on relevant medical opinions, and obtain the cost control rules for each necessary and unnecessary medical procedure.

[0091] Step S203: Determine multiple combined medical items for each price range according to the cost control rules, and obtain the expected effect prospects of each combined medical item for the physician;

[0092] Step S204: Select the target combination of medical projects based on the expected outcome, and determine the final clinical pathway based on the target combination of medical projects.

[0093] The beneficial effects of the above technical solution are as follows: Based on the diagnosis and treatment opinions, necessary and non-necessary medical items and their respective cost control rules are determined, thereby identifying multiple combinations of medical items and expected outcomes for each price range. This can reduce unreasonable diagnosis and treatment behaviors driven by economic interests, improve medical quality and patient experience, and further, determine the final implementation clinical pathway based on the target combination of medical items. This can transform the diagnosis and treatment opinions into standardized medical processes, reduce inconsistencies in diagnosis and treatment due to individual differences, ensure the standardization and consistency of medical services, and improve patient treatment safety.

[0094] In one embodiment, such as Figure 3 As shown, the step of obtaining the final clinical pathway implementation monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators, and monitoring the medical process of the target patient based on these indicators, includes:

[0095] Step S301: Determine the reference indicators for enrollment rate, completion rate, and cost for the final implementation of the clinical pathway;

[0096] Step S302: Based on the enrollment rate reference index, completion rate reference index, and cost reference index, obtain the final clinical pathway implementation progress monitoring index, pathway quality monitoring index, and pathway cost monitoring index.

[0097] Step S303: Determine the monitoring objects and monitoring processes based on the path progress monitoring indicators, path quality monitoring indicators, and path cost monitoring indicators;

[0098] Step S304: Perform data monitoring on the monitored object according to the monitoring process to achieve monitoring of the medical process of the target patient.

[0099] The beneficial effects of the above technical solution are as follows: by obtaining multiple indicators of the progress of the final clinical pathway based on multiple indicators, the monitoring objects and monitoring processes can be determined, the treatment process can be monitored in real time, the authenticity of the medical process can be improved, and the problem of being unable to trace the source when medical disputes occur can be avoided.

[0100] In one embodiment, determining the treatment resources corresponding to the treatment methods for clinical symptoms, determining the relevant diagnostic departments based on the treatment resources, and determining multiple clinical pathways for different diseases based on the relevant diagnostic departments include:

[0101] The clinical disease treatment methods are broken down to determine the corresponding required drug resources, equipment resources, human resources and space resources;

[0102] Drug resources, equipment resources, human resources, and space resources are categorized as treatment resources, and multiple resource types of treatment resources are identified.

[0103] Match diagnostic-related departments based on resource type, and determine the leading and collaborating departments within the diagnostic-related departments, as well as the collaborative working mechanism between them;

[0104] Diagnostic and treatment process parameters are determined based on the leading and collaborating departments and their collaborative working mechanism. Clinical pathways for multiple diseases are then determined based on these parameters and rehabilitation indicators.

[0105] The beneficial effects of the above technical solution are as follows: by decomposing the treatment methods for clinical diseases and determining their corresponding treatment resources, and matching the relevant diagnostic departments according to the treatment resources, patients can be more accurately assigned to the most suitable departments and treatment teams, avoiding waste of resources. Furthermore, by determining the collaborative working mechanism between the leading and collaborating departments in the relevant diagnostic departments, the diagnostic process parameters and treatment process parameters, as well as clinical pathways for multiple diseases, can be determined, which can standardize medical behavior, reduce inconsistencies in treatment caused by individual differences, and improve patient safety.

[0106] In one embodiment, the step of determining multiple treatment items based on the medical insurance version of the clinical pathway form, obtaining the cost structure of each treatment item, and defining multiple cost units based on the cost structure includes:

[0107] The medical insurance version of the clinical pathway form is broken down into multiple treatment items according to the timeline, and the item attributes of each medical item are determined. The item attributes include: mandatory items and optional items.

[0108] Determine each necessary medical procedure based on the project attributes, obtain the fee details for the necessary medical procedures, and determine the details of direct medical expenses and indirect medical expenses based on the fee details;

[0109] The cost structure for each necessary medical procedure is determined based on the details of direct and indirect medical expenses.

[0110] Based on the cost structure, multiple definition dimensions are determined, and multiple cost units for necessary medical procedures are defined through multiple positioning dimensions. The definition dimensions include: cost type, cost nature, and cost stage.

[0111] The beneficial effects of the above technical solution are as follows: each necessary diagnosis and treatment item and related fee details are determined according to the project attributes of each medical project. The cost structure and multiple definition dimensions are determined according to the fee details, which can more accurately determine the cost composition and avoid unnecessary problems caused by a lack of understanding of the payment process. Furthermore, by defining multiple cost units for necessary diagnosis and treatment items through multiple positioning dimensions, reasonable cost unit definitions can prevent patients from incurring high medical costs due to unnecessary examinations and treatments, and ensure that patients receive high-quality medical services while paying reasonable fees.

[0112] In one embodiment, after obtaining the medical insurance version of the clinical pathway form, the method further includes:

[0113] Obtain historical treatment information of target patients based on disease type, determine medical data of target patients based on historical treatment information, and determine overall medical concepts for target patients based on medical data;

[0114] Based on the overall medical concept, determine the diagnostic and treatment decision factors for the target patient, and then determine the medical field based on the diagnostic and treatment decision factors;

[0115] Acquire clinical rules in the medical field, determine multiple diagnostic and treatment reference features for target patients based on clinical rules, and determine the key information elements included in the medical insurance version of the clinical pathway form based on the diagnostic and treatment reference features through a preset medical knowledge model.

[0116] Obtain mapping indicators for key information elements, and determine the key and non-key treatment items in the medical insurance version of the clinical pathway form based on the mapping indicators;

[0117] Determine the medical correlation parameters between the excluded treatment items and the key treatment items, and determine the parallel binding relationship between the excluded treatment items and the key treatment items based on the medical correlation parameters;

[0118] Based on the parallel and bundled nature of the clinical pathway form for medical insurance, determine the treatment items to be added and obtain the target treatment stage of the treatment items to be added.

[0119] Obtain the phase goals for the target treatment phase, determine the core treatment project group based on the phase goals, and confirm whether the core treatment project group includes any treatment projects to be added.

[0120] If yes, add the treatment items to be added to the medical insurance version of the clinical pathway form to generate a new medical insurance version of the clinical pathway form; otherwise, confirm that no treatment items need to be added.

[0121] An initial sequence of treatment nodes is generated based on the new medical insurance version of the clinical pathway form by using a pre-set comprehensive treatment information model.

[0122] A dynamic adjustment mechanism is generated based on the initial treatment node sequence and the appointment strategy for each treatment item. This mechanism is used to adjust the new medical insurance version of the clinical pathway form in real time.

[0123] The beneficial effects of the above technical solution are as follows: By adjusting the new medical insurance version of the clinical pathway form in real time, the order of the diagnosis and treatment items in the new medical insurance version of the clinical pathway form can be adjusted according to the real-time allocation of diagnosis and treatment resources, so that medical staff can quickly perform related diagnosis and treatment work, thereby improving work efficiency. Furthermore, by evaluating the associated and bundled diagnosis and treatment items in the obtained medical insurance version of the clinical pathway form according to medical goals, it can be ensured that the diagnosis and treatment process is fully in place without omission, thereby improving the efficiency and stability of diagnosis and treatment.

[0124] In one embodiment, after determining clinical pathways for multiple diseases based on diagnostic-related departments, the method further includes:

[0125] Determine the resource type corresponding to each disease clinical pathway, determine the medical resource usage level based on the resource type, and determine the medical resource occupancy cost index for each disease clinical pathway based on the medical resource usage level;

[0126] Obtain the frequency of single operations and the frequency of multiple collaborative operations for each disease's clinical pathway, and determine the operational complexity index of each disease's clinical pathway based on the frequency of single operations and the frequency of multiple collaborative operations.

[0127] Obtain the human resource allocation parameters for each disease's clinical pathway, and determine the human resource cost index for each disease's clinical pathway based on the human resource allocation parameters and collaborative operation process parameters;

[0128] The recommended fit of each disease's clinical pathway is calculated based on its human resource cost index, operational complexity index, and medical resource occupancy cost index.

[0129]

[0130] Among them, F i Let A represent the recommended fit of the clinical pathway for the i-th disease. i Let B represent the human resource cost index for the clinical pathway of the i-th disease, where μ1 represents the first weight and has a value of 0.3. i Let C represent the operational complexity index of the clinical pathway for the i-th disease, and μ2 represent the second weight with a value of 0.3. i Let represent the medical resource occupancy cost index of the clinical pathway for the i-th disease, μ3 represent the third weight with a value of 0.4, ln represent the natural logarithm, and d i Let h represent the diagnostic and treatment fit factor between the clinical pathway for the i-th disease and the target patient's disease type. i S represents the threshold of the positive medical effect of the clinical pathway for the i-th disease. i This represents the threshold of negative medical effects for the clinical pathway of the i-th disease.

[0131] Based on the recommended fit of each disease clinical pathway, the first disease clinical pathway with a value greater than or equal to the preset threshold is selected, and the second disease clinical pathway with a value less than the preset threshold is removed.

[0132] The clinical pathway for the first disease will be used as a reference clinical pathway for the medical insurance version of the clinical pathway form for the target patients.

[0133] The beneficial effects of the above technical solution are as follows: by calculating the recommended suitability of clinical pathways for each disease, the cost of each clinical pathway can be evaluated from multiple perspectives. This not only ensures the suitability of the selected clinical pathways but also improves the quality of medical care, further avoids unnecessary consumption by patients, and enhances the patient experience.

[0134] In one embodiment, this embodiment also discloses a clinical pathway monitoring system based on the DRG / DIP payment model, such as... Figure 4 As shown, the system includes:

[0135] Module 401 is used to determine the disease type of the target patient and to develop a medical insurance version of the clinical pathway form for the target patient based on the disease type.

[0136] The optimization module 402 is used to determine the treatment item coefficients of each clinical pathway in the medical insurance version of the clinical pathway form through historical treatment data, and to optimize the medical insurance version of the clinical pathway form based on the treatment item coefficients.

[0137] Module 403 is used to obtain relevant medical opinions from professional physicians on the optimized medical insurance version of the clinical pathway form, and to determine the final clinical pathway to be implemented based on the relevant medical opinions.

[0138] The monitoring module 404 is used to acquire the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators of the final clinical pathway implementation, and to monitor the medical process of the target patient based on the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators.

[0139] The working principle and beneficial effects of the above technical solution have been explained in the method embodiments, and will not be repeated here.

[0140] Those skilled in the art should understand that the "first" and "second" in this invention simply refer to different application stages.

[0141] Other embodiments of this disclosure will readily occur to those skilled in the art upon consideration of the specification and practice of the disclosure herein. This application is intended to cover any variations, uses, or adaptations of this disclosure that follow the general principles of this disclosure and include common knowledge or customary techniques in the art not disclosed herein. The specification and examples are to be considered exemplary only, and the true scope and spirit of this disclosure are indicated by the following claims.

[0142] It should be understood that this disclosure is not limited to the precise structures described above and shown in the accompanying drawings, and various modifications and changes can be made without departing from its scope. The scope of this disclosure is limited only by the appended claims.

Claims

1. A clinical pathway monitoring method based on the DRG / DIP payment model, characterized in that, Includes the following steps: Determine the disease type of the target patients and develop a medical insurance version of the clinical pathway form for the target patients based on the disease type; The coefficients of treatment items for each clinical pathway in the medical insurance version of the clinical pathway form are determined by using historical treatment data, and the medical insurance version of the clinical pathway form is optimized based on the coefficients of treatment items. Obtain relevant medical opinions from professional physicians regarding the optimized medical insurance version of the clinical pathway form, and determine the final clinical pathway to be implemented based on these opinions; Obtain the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators for the final implementation of the clinical pathway, and monitor the medical process of the target patients based on the pathway progress monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators. After obtaining the medical insurance version of the clinical pathway form, it also includes: Obtain historical treatment information of target patients based on disease type, determine medical data of target patients based on historical treatment information, and determine overall medical concepts for target patients based on medical data; Based on the overall medical concept, determine the diagnostic and treatment decision factors for the target patient, and then determine the medical field based on the diagnostic and treatment decision factors; Acquire clinical rules in the medical field, determine multiple diagnostic and treatment reference features for target patients based on clinical rules, and determine the key information elements included in the medical insurance version of the clinical pathway form based on the diagnostic and treatment reference features through a preset medical knowledge model. Obtain mapping indicators for key information elements, and determine the key and non-key treatment items in the medical insurance version of the clinical pathway form based on the mapping indicators; Determine the medical correlation parameters between the excluded treatment items and the key treatment items, and determine the parallel binding relationship between the excluded treatment items and the key treatment items based on the medical correlation parameters; Based on the parallel and bundled nature of the clinical pathway form for medical insurance, determine the treatment items to be added and obtain the target treatment stage of the treatment items to be added. Obtain the phase goals for the target treatment phase, determine the core treatment project group based on the phase goals, and confirm whether the core treatment project group includes treatment projects to be added; If yes, add the treatment items to be added to the medical insurance version of the clinical pathway form to generate a new medical insurance version of the clinical pathway form; otherwise, confirm that no treatment items need to be added. An initial sequence of treatment nodes is generated based on the new medical insurance version of the clinical pathway form by using a pre-set comprehensive treatment information model. A dynamic adjustment mechanism is generated based on the initial treatment node sequence and the appointment strategy for each treatment item. This mechanism is used to adjust the new medical insurance version of the clinical pathway form in real time.

2. The clinical pathway monitoring method based on the DRG / DIP payment model according to claim 1, characterized in that, The process of determining the disease type of the target patient and developing a medical insurance version of the clinical pathway form for the target patient based on the disease type includes: Obtain the medical records of the target patients, determine the disease type of the target patients based on the medical records, and determine the clinical treatment methods based on the disease type; Determine the treatment resources corresponding to the treatment methods for clinical symptoms, determine the relevant departments based on the treatment resources, and determine clinical pathways for multiple diseases based on the relevant departments. Obtain the DRG payment standard for each disease clinical pathway, and develop a medical insurance version of the clinical pathway form for the target patients based on the DRG payment standard.

3. The clinical pathway monitoring method based on the DRG / DIP payment model according to claim 1, characterized in that, The process of determining the treatment item coefficients for each clinical pathway in the medical insurance version of the clinical pathway form using historical treatment data, and optimizing the medical insurance version of the clinical pathway form based on these treatment item coefficients, includes: Based on the medical insurance version of the clinical pathway form, multiple treatment items are identified, the cost structure of each treatment item is obtained, and multiple cost units are defined based on the cost structure. Collect historical treatment data for each diagnostic and treatment item, and determine the historical treatment cost data for each diagnostic and treatment item based on the historical treatment data; Frequency statistics were performed on multiple cost units using historical data on medical expenses, and the coefficients of medical items for each clinical pathway in the medical insurance version of the clinical pathway form were determined based on the statistical results. Based on the coefficient of the clinical pathway, the first treatment item with a value greater than or equal to a preset threshold is selected and designated as a mandatory treatment item, while the second treatment item with a value less than the preset threshold is designated as a non-mandatory treatment item. The medical insurance version of the clinical pathway form is then optimized based on the classification results.

4. The clinical pathway monitoring method based on the DRG / DIP payment model according to claim 1, characterized in that, The process of obtaining relevant medical opinions from professional physicians regarding the optimized medical insurance version of the clinical pathway form, and determining the final implementation of the clinical pathway based on these opinions, includes: Upload the optimized medical insurance version of the clinical pathway form to the professional physician's terminal and obtain relevant diagnosis and treatment opinions from the terminal; Based on relevant medical opinions, determine the necessary and non-necessary medical procedures, and obtain the cost control rules for each of the necessary and non-necessary medical procedures. Based on cost control rules, multiple combinations of medical items are determined for each price range, and the expected outcomes of each combination of medical items are obtained from the physicians. Select target combination medical projects based on the expected outcomes, and determine the final clinical pathway based on the target combination medical projects.

5. The clinical pathway monitoring method based on the DRG / DIP payment model according to claim 1, characterized in that, The process of acquiring the final clinical pathway implementation monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators, and monitoring the medical process of the target patient based on these indicators, includes: Determine the reference indicators for enrollment rate, completion rate, and cost for the final implementation of the clinical pathway; Based on the reference indicators of enrollment rate, completion rate, and cost, obtain the final clinical pathway implementation monitoring indicators, pathway quality monitoring indicators, and pathway cost monitoring indicators. The monitoring objects and monitoring processes are determined based on the path progress monitoring indicators, path quality monitoring indicators, and path cost monitoring indicators. Data monitoring is performed on the monitored objects according to the monitoring process to achieve monitoring of the medical process of the target patients.

6. The clinical pathway monitoring method based on the DRG / DIP payment model according to claim 2, characterized in that, The process involves determining the treatment resources corresponding to the clinical disease treatment methods, identifying the relevant diagnostic departments based on these resources, and determining clinical pathways for multiple diseases based on these relevant departments, including: The clinical disease treatment methods are broken down to determine the corresponding required drug resources, equipment resources, human resources and space resources; Drug resources, equipment resources, human resources, and space resources are categorized as treatment resources, and multiple resource types of treatment resources are identified. Match diagnostic-related departments based on resource type, and determine the leading and collaborating departments within the diagnostic-related departments, as well as the collaborative working mechanism between them; Diagnostic and treatment process parameters are determined based on the leading and collaborating departments and their collaborative working mechanism. Clinical pathways for multiple diseases are then determined based on these parameters and rehabilitation indicators.

7. The clinical pathway monitoring method based on the DRG / DIP payment model according to claim 3, characterized in that, The process involves determining multiple treatment items based on the medical insurance version of the clinical pathway form, obtaining the cost structure for each treatment item, and defining multiple cost units based on the cost structure, including: The medical insurance version of the clinical pathway form is broken down into multiple treatment items according to the timeline, and the item attributes of each medical item are determined. The item attributes include: mandatory items and optional items. Determine each necessary medical procedure based on the project attributes, obtain the fee details for the necessary medical procedures, and determine the details of direct medical expenses and indirect medical expenses based on the fee details; The cost structure for each necessary medical procedure is determined based on the details of direct and indirect medical expenses. Based on the cost structure, multiple definition dimensions are determined, and multiple cost units for necessary medical procedures are defined through multiple positioning dimensions. The definition dimensions include: cost type, cost nature, and cost stage.

8. The clinical pathway monitoring method based on the DRG / DIP payment model according to claim 2, characterized in that, After determining clinical pathways for multiple diseases based on the relevant diagnostic departments, it also includes: Determine the resource type corresponding to each disease clinical pathway, determine the medical resource usage level based on the resource type, and determine the medical resource occupancy cost index for each disease clinical pathway based on the medical resource usage level; Obtain the frequency of single operations and the frequency of multiple collaborative operations for each disease's clinical pathway, and determine the operational complexity index of each disease's clinical pathway based on the frequency of single operations and the frequency of multiple collaborative operations. Obtain the human resource allocation parameters for each disease's clinical pathway, and determine the human resource cost index for each disease's clinical pathway based on the human resource allocation parameters and collaborative operation process parameters; The recommended fit of each disease clinical pathway is calculated based on the human cost index, operational complexity index, and medical resource occupation cost index of each disease clinical pathway. Based on the recommended fit of each disease clinical pathway, the first disease clinical pathway with a value greater than or equal to the preset threshold is selected, and the second disease clinical pathway with a value less than the preset threshold is removed. The clinical pathway for the first disease will be used as a reference clinical pathway for the medical insurance version of the clinical pathway form for the target patients.

9. A clinical pathway monitoring system based on the DRG / DIP payment model, characterized in that, The system includes: The module is used to determine the disease type of the target patient and to develop a medical insurance version of the clinical pathway form for the target patient based on the disease type. The optimization module is used to determine the treatment item coefficients of each clinical pathway in the medical insurance version of the clinical pathway form through historical treatment data, and optimize the medical insurance version of the clinical pathway form based on the treatment item coefficients. The determination module is used to obtain relevant medical opinions from professional physicians on the optimized medical insurance version of the clinical pathway form, and to determine the final clinical pathway to be implemented based on the relevant medical opinions. The monitoring module is used to acquire the progress monitoring indicators, quality monitoring indicators, and cost monitoring indicators of the final clinical pathway, and to monitor the medical process of the target patient based on the progress monitoring indicators, quality monitoring indicators, and cost monitoring indicators. After obtaining the medical insurance version of the clinical pathway form, it also includes: Obtain historical treatment information of target patients based on disease type, determine medical data of target patients based on historical treatment information, and determine overall medical concepts for target patients based on medical data; Based on the overall medical concept, determine the diagnostic and treatment decision factors for the target patient, and then determine the medical field based on the diagnostic and treatment decision factors; Acquire clinical rules in the medical field, determine multiple diagnostic and treatment reference features for target patients based on clinical rules, and determine the key information elements included in the medical insurance version of the clinical pathway form based on the diagnostic and treatment reference features through a preset medical knowledge model. Obtain mapping indicators for key information elements, and determine the key and non-key treatment items in the medical insurance version of the clinical pathway form based on the mapping indicators; Determine the medical correlation parameters between the excluded treatment items and the key treatment items, and determine the parallel binding relationship between the excluded treatment items and the key treatment items based on the medical correlation parameters; Based on the parallel and bundled nature of the clinical pathway form for medical insurance, determine the treatment items to be added and obtain the target treatment stage of the treatment items to be added. Obtain the phase goals for the target treatment phase, determine the core treatment project group based on the phase goals, and confirm whether the core treatment project group includes treatment projects to be added; If yes, add the treatment items to be added to the medical insurance version of the clinical pathway form to generate a new medical insurance version of the clinical pathway form; otherwise, confirm that no treatment items need to be added. An initial sequence of treatment nodes is generated based on the new medical insurance version of the clinical pathway form by using a pre-set comprehensive treatment information model. A dynamic adjustment mechanism is generated based on the initial treatment node sequence and the appointment strategy for each treatment item. This mechanism is used to adjust the new medical insurance version of the clinical pathway form in real time.

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