建置呼吸系統疾病診斷關係群決策支援系統

Development of the Decision Support System for Diagnosis Related Grouping of Hospital Respiratory Diseases

為有效控制醫療費用成長，醫療保險實施總額預算制度，行政院衛生署為總額支付制度奠定合理的支付基準，擬將住院醫療費用採診斷關係群方式支付。本研究以南部某區域教學醫院之住院呼吸系統疾病申報資料為基礎，應用Delphi系統開發工具，建置一診斷關係群決策支援系統，期望運用決策支援系統輔助疾病分類人員，避免因人為因素造成編碼過度或不足的疏失，亦即透過系統輔助提昇疾病分類人員主要診斷選取正確性；及最佳化DRG代碼提示以支援編碼人員思考代碼完整性。結果顯示決策支援系統輔助比傳統人工作業有較佳的效果。

In order to effectively control the growth of medical expenditure, the medical insurance organizations adopted the Global Budget System. The Department of Health, Executive Yuan, to establish the basis of this payment system planned to adopt Diagnosis Related Groups on hospital medical expenditure. This study used system development tool, Delphi, to build a 'Diagnosis Related Groups Decision Support System (DRGDSS)', based on the medical information of inpatients with respiratory system diseases, to assist disease classifying coding personnel. The results showed that using the DRGDSS enhanced the effectiveness of disease classifying coding and further led to correct and reasonable medical reimbursement.