运用PDCA循环缩短医保病历审核时间

摘要

Objectives: To explore the effective ways in shortening the review time of medical records in medical insurance patients and to provide reference for continuous improving efficiency and the quality of service. Methods: PDCA circulation was applied to analyze the factors that affecting the review time, identify the main causes and develop the improvement measures. Results: After implementing the PDCA circle, the institution, business process, information system and management methods have been improved. The numbers of review elevated from 3.55 to 4.72 per day, increased 33.1%. Conclusions: PDCA circulation significantly shorted the review time of medical records in the medical insurance patients, and continuously improving the efficiency and quality of medical insurance management.%目的：探讨缩短医保病历审核时间的有效方式，为提高审核效率、不断改善服务质量提供参考依据。方法：运用PDCA循环原理，对影响医保病历审核的因素进行分析，找出其中的主要原因，制定针对性措施实施过程改进。结果：实施改进措施后，通过进一步修订制度、改进流程、引入电子化系统及加强管理等方面，人均日审核病历份数由原先3.55份提升至4.72份，提升率达33.1%。结论：PDCA循环的应用缩短了医保病历审核时间，实现医院医保审核质量及效率的持续提高。