摘要
目前医院普遍存在医保基金使用及管理手段滞后的问题,对同一病种临床路径实际执行过程差异性大且缺乏规范性,对医保基金的合理使用评价和改进都存在困难。本项目以真实世界医疗数据为导向开展医保费用模型构建及辅助决策应用。产学研合作形成软件产品及知识库,培育新型医保管理服务模式。通过充分发挥数据要素×效应:(1)有助于减轻百姓医疗负担,提升居民幸福度;(2)有助于规范医院诊疗行为,提升医院医疗服务能力,体现公立医院的公益性;(3)有助于辅助政府监督管理,实现区域-医院-科室三级联动,提高综合服务能力;(4)有助于撬动数据资产赋能,形成产学研用的大数据产业发展模式,具有先进性、创新性、示范性。
At present,hospitals generally have outdated management methods for the use of medical insurance funds,and there are significant differences and lack of standardization in the actual implementation process of clinical pathways for the same disease.In addition,there are difficulties in evaluating and improving the reasonable use of medical insurance funds.This project is guided by real-world medical data to construct a medical insurance expense model and develop decision-support applications.Through industry-university-research cooperation,it develops software products and a knowledge base,fostering a new model of medical insurance management services.By fully leveraging the data element effect,(1)it helps reduce the medical burden on the public and improve residents’well-being;(2)it helps standardize hospital diagnosis and treatment practices,enhance medical service capabilities,and reflect the public welfare nature of public hospitals;(3)it assists government supervision and management,achieving three-level coordination among regions,hospitals,and departments to improve comprehensive service capacity;(4)it helps unlock the empowering potential of data assets,fostering an integrated big data industry model involving industry,academia,research,and application,demonstrating progressiveness,innovativeness,and exemplarity.
作者
花磊
李炯莹
刘丽
Hua Lei;Li Jiongying;Liu Li(Affiliated Hospital of Jiangnan University,Wuxi 214000,China)
出处
《办公自动化》
2025年第24期107-110,共4页
Office Informatization
基金
无锡市科技局太湖之光科技攻关(医疗卫生)项目资助(NO.Y20232001)结直肠癌智能化早筛模型构建及辅助决策应用研究
无锡市卫生健康委科研项目资助(NO.Z202309)基于真实世界大数据的结直肠癌规范诊疗模型构建与转化应用
科技部国家重点研发计划《重症护理智能机器人系统研发》项目协作单位课题(NO.HLJORS_2023A07)基于患者安全的风险监测预警干预技术及智能化管理模式研究。
关键词
大数据
数据建模
医保
辅助决策
医疗管理
big data
data modeling
medical insurance
decision support
medical management
