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目的探寻提高医院信息上报质量的有效事前介入对策。方法采用对比法、卡方检验、柏拉图等方法分析信息上报事前介入之前和介入之后的信息质量改进效果。结果 2013年6月-10月信息总体报错率较1月-5月显著下降,其中因血型值、主要诊断编码等错误的报错率显著降低;因门急诊诊断、其他诊断编码等错误的报错率前后无显著差异;因病理诊断编码错误、婴儿信息丢失的报错率显著提升。信息的主要错误项得到了有效改善,个别错误已杜绝。结论制定并细化考核制度、维护编码库、加强系统判断功能、建立院内分级培训机制等事前介入对策,信息上报质量明显提高,但还需持续改进。
Objective To explore an effective intervention in advance to improve the quality of hospital information reporting. Methods The methods of contrast, chi-square test and Plato were used to analyze the information quality improvement before and after intervention. Results The overall error rate of information in June-October 2013 was significantly lower than that in January-May 2013, of which the error rate was significantly lower due to the blood type value and the main diagnosis code. Due to the error rate of diagnosis in other departments and hospitals, No significant difference before and after; due to pathological diagnosis coding error, the error rate of infant information loss significantly improved. The main mistakes of information have been effectively improved, and some mistakes have been eliminated. Conclusion In order to formulate and refine the examination system, maintain the code base, strengthen the system judgment function and establish the intra-hospital grading training mechanism and other intervention measures, the quality of information reporting is obviously improved, but the improvement is still needed.