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“依码支付”背景下儿童医院药品追溯码管理体系的升级与实践
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| 篇名： | “依码支付”背景下儿童医院药品追溯码管理体系的升级与实践 |
| TITLE： | Upgrade and practice of the drug traceability code management system in children’s hospital under the “payment by code”background |
| 摘要： | 目的 在医保“依码支付”背景下，升级适用于儿童专科医院的药品追溯码管理体系，以全面提升药品追溯的完整性、效率与合规水平。方法以厦门市儿童医院为实施场景，采用前后对照设计，通过技术平台、核心机制与医保协同的系统性升级，构建药品追溯码智能管理体系。具体措施包括：升级追溯码基础管理平台并设计动态追溯码池；创新常规、拆零及特殊药品的差异化追溯机制；建立分级预警与应急处理流程；构建医保数据协同与质量控制系统。以药品追溯码上传率为核心指标，分析未上传问题的根因分布、退药操作时长等过程性指标，以及医保异常处方标记数等综合成效指标，对比基线期（2025年4月）与观察期（2025年6－8月）的数据并进行效果评价。结果升级后，药品追溯码整体上传率从基线期的9.21%提升至观察期末（2025年8月）的99.86%，住院药房及静脉用药集中调配中心等管理盲区追溯码上传率从0跃升至近100%。系统性原因导致的未上传占比自观察期初（2025年6月）的66.44%降至观察期末（2025年8月）的2.62%。此外，被医保标记的异常处方数从“依码支付”政策落地首月（2025年7月）的2275.00条骤降至观察期末（2025年8月）的212.00条，降幅达90.70%。结论本研究构建的药品追溯码管理体系能有效应对高频拆零等复杂场景挑战，显著提升追溯码上传成功率与医保合规性，控制医保拒付风险，优化药学服务流程。 |
| ABSTRACT： | OBJECTIVE To upgrade the drug traceability code management system for a pediatric hospital under the “payment by code” background， aiming to comprehensively enhance traceability integrity， efficiency， and compliance. METHODS Taking Xiamen Children’s Hospital as the implementation setting， a before-and-after control design was adopted to construct an intelligent drug traceability code management system through systematic upgrades involving the technology platform， core mechanisms， and coordination with medical insurance. Key interventions included： upgrading a traceability code management platform and designing a dynamic code pool； innovating differentiated traceability mechanisms for routine， split-dose， and special drugs； establishing a tiered early-warning and emergency response system； and constructing a data coordination and quality control system. The drug traceability code upload rate served as the primary outcome. Process indicators such as the root causes distribution of failed uploads and the duration of medication returns， and a comprehensive outcome （the number of insurance-flagged abnormal prescriptions） were also analyzed. The data between the baseline period （April 2025） and the observation period （June-August 2025） were compared and evaluated. RESULTS After the upgrade， the overall upload rate of drug traceability codes increased from 9.21% （baseline） to 99.86% （August 2025）. The upload rate of traceability codes in previously unmanaged areas， such as the inpatient pharmacy and pharmacy intravenous admixture services， soared from 0 to nearly 100%. The proportion of non-uploads due to system issues fell from 66.44% （June 2025） to 2.62% （August Additionally， the number of insurance-flagged） abnormal prescriptions dropped sharply from 2 275.00 in the first “payment by code” policy month （July 2025） to 212.00 by the end of the observation period （August 2025）， a 90.70% decrease. CONCLUSIONS The developed management system effectively addresses complex scenario challenges such as high-frequency drug splitting. It significantly enhances traceability code upload performance and ensures a high degree of compliance with medical insurance data requirements. These outcomes contribute to proactive risk mitigation against insurance claim denials and demonstrate a concurrent optimization of pharmacy operations. |
| 期刊： | 2026年第37卷第03期 |
| 作者： | 林金香；李苏平；苏燕青；叶德辉；陈娴雯；陈钰霜；纪志慧；赖东川；吴夏阳 |
| AUTHORS： | LIN Jinxiang， LI Suping，SU Yanqing，YE Dehui，CHEN Xianwen，CHEN Yushuang，JI Zhihui，LAI Dongchuan，WU Xiayang |
| 关键字： | 依码支付；药品追溯码；拆零药品；信息系统；医疗机构 |
| KEYWORDS： | payment by code； drug traceability code； splitting drug； information system； medical institutions |
| 阅读数： | 2 次 |
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