Propuesta de adaptación de GRD para el modelo de atención de pacientes con enfermedad mental en una Ips de alto nivel de complejidad especializada en salud mental
Thesis
The general objective of this project is to develop a disease management model, centered on the patient and focused on clinical risk, which involves a system of groups related by diagnosis (DRG) through specific objectives such as: characterization of patients by groups of disease and the creation of patient-centered healthcare pathways in order to achieve the best health outcomes. This document is divided into 5 sections, among which are: the first section corresponds to the importance of payment systems in the health sector and DRGs, the second describes the business problems with respect to the management model, in the third There are strategies and actions to solve the previous point, the fourth section corresponds to the implementation and application plan and finally we will show the conclusions of the project. The main problem that arises in terms of contracting by package or grouped payment in the mental health sector is ineffective management and poor control from the point of view of profitability (income / expense) added to poor control of the disease , high level of complications and deterioration in the quality of life of patients, generating an increase in the number of hospitalizations, more days of stay, less control of their mental pathologies, preventable complications and a high cost for the system. It was first considered to define DRG with applicability for Colombia, focused on ICD-10 and DSM 5, which allows grouping patients to carry out effective management from a clinical, administrative, financial and technological point of view. A service model was designed focused on care routes and the use of resources corresponding to each DRG, allowing the first step to intervene indicators of clinical results, user satisfaction and sustainability of the package.
