A study of discrepancies of diagnosis and procedures of patients in the field of Internal Medicine of Thammasat University Hospital

Abstract

Background: The summary of diagnosis and medical procedures sometimes were in complete in its details and accuracy. These issues have affected the reimbursement of medical expenses, causing expenses, from related aqencies and leads to loss of income of the hospital.

Objective: 1) To study inaccuracy in the summary disease of diagnosis and procedures from the In-Patient Summary document of the Internal Medicine Department of Thammasat University Hospital. 2) To compare the difference in AdjRW, and medical expenses before and after detecting discrepancies in the summary disease of diagnosis and procedures from the In-Patient Summary document.

Material and methods: The sample group was medical records of patients in the field of internal medicine from January to June 2021 with specific reimbursement rights such as. rights belonging to the Comptroller General’s Department and civil servants Bangkok local government organization,universal health insurance,and social security. We were reviewed used the criteria to evaluate the summary assessment of diagnosis and  procedures, summary assessment(SA) version 2018, Data were analyzed by a descriptive method about frequency and percent and compare the difference in AdjRW of expense for medical treatment.

Result: A sample of 1,184 cases were reviewed. discrepancies in 455 documents (38.43%) were found. Based on discrepancies ,1465.4207 AdjRW was increded. The total amount was 17,066,879 baht which were highlighted in (58.68%)  of the Agency rights under The Comptroller General’s Department moreover, the summary diagnoses of comorbidities, complications of the incorrect disease, and procedure summary (SA) were not summarized in 42.86%. 

Conclusion: The summary of disease diagnosis and procedures must be accurate, and complete. These are important for the hospitals, reimbursement. therefore the hospital will receive more compensation from its service.