面向DRG的集成化医疗服务成本管理模式与方法研究

发布时间：2018-01-15 06:26

本文关键词：面向DRG的集成化医疗服务成本管理模式与方法研究　出处：《天津大学》2013年博士论文　论文类型：学位论文

【摘要】：本文从集成化管理的角度研究面向DRG的医疗服务成本管理，针对医疗服务成本管理研究现状和我国医院推行DRG存在的实际成本管理问题，应用集成化、系统化的思想，，研究了面向DRG的集成化医疗服务成本管理的基本理论和管理模式，并针对病种成本预测和控制的特点及存在的问题进行了深入研究，主要研究成果如下：第一，对当前国内外关于医疗服务成本管理的研究文献进行了分类、分析和评述，进而论述了目前医疗服务成本管理的主要研究方向，并在此基础上提出了本文所要研究的主要问题。第二，分析了DRG对医疗服务成本管理的影响，研究并分析了面向DRG的集成化医疗服务成本管理的体系结构、特征，构建了实施面向DRG的集成化医疗服务成本管理的理论框架，然后，在此基础上，提出并构建了面向DRG的集成化医疗服务成本管理模式的框架模型，并对系统框架的构成和特征进行了详细的说明。第三，根据病种成本管理的需要，建立病种成本数据仓库模型。然后，基于类物料清单（GBOM）构建了单病种及病种系列成本影响因素表达模型，并进行数学描述。最后，运用粗糙集理论构建了病种成本影响因素约简模型，并进行了应用研究。第四，针对病种成本预测方法展开研究。首先，提出了基于知识发现（KDD）的病种成本预测系统框架。然后，重点研究了基于SVM的单病种成本预测方法和基于PSO优化SVM的DRG病种系列成本预测方法。第五，针对病种成本控制方法展开研究。首先，将预测控制的思想引入病种成本控制，提出了病种成本预测控制的模式。然后，将EWMA控制图和LSSVM引入病种成本控制，建立了基于EWMA控制图和LSSVM的病种成本预测控制模型和基于GA优化LSSVM的病种成本差异识别模型。第六，面向成本的医疗服务运营优化策略。在分析我国医疗服务运营存在的问题的基础上，从医院设施和人员配置的角度运用排队论、系统仿真以及整数规划等方法研究降低病种成本的策略。
[Abstract]:This paper studies the DRG oriented medical service cost management from the perspective of integrated management. Aiming at the current research situation of medical service cost management and the actual cost management problems existing in the implementation of DRG in Chinese hospitals, the application of integration. Based on the systematic idea, the basic theory and management model of integrated medical service cost management for DRG are studied, and the characteristics and problems of disease cost prediction and control are deeply studied. The main findings are as follows: First, the research literature on medical service cost management at home and abroad has been classified, analyzed and commented, and then discussed the main research direction of medical service cost management. On this basis, the main problems to be studied in this paper are put forward. Secondly, this paper analyzes the impact of DRG on the cost management of medical services, studies and analyzes the architecture and characteristics of integrated cost management of medical services for DRG. The theoretical framework of implementing integrated medical service cost management for DRG is constructed, and then, on this basis, the framework model of integrated medical service cost management model oriented to DRG is proposed and constructed. The structure and characteristics of the system framework are explained in detail. Thirdly, according to the need of disease cost management, the data warehouse model of disease cost is established. Then, based on the GBOM, the expression model of single disease and disease series cost influencing factors is constructed. Finally, using rough set theory to construct the reduction model of the factors affecting the disease cost, and carry on the application research. In 4th, the cost forecasting method of disease species was studied. Firstly, the framework of disease cost forecasting system based on KDD was proposed. The cost forecasting method of single disease based on SVM and series cost forecasting method of DRG disease based on PSO optimization SVM were studied. In 5th, the method of disease cost control was studied. Firstly, the idea of predictive control was introduced into disease cost control, and the model of disease cost predictive control was put forward. EWMA control chart and LSSVM were introduced into disease cost control. The predictive control model of disease cost based on EWMA control chart and LSSVM and the differential identification model of disease cost based on GA optimized LSSVM were established. 6th, a cost-oriented optimization strategy for medical service operation. Based on the analysis of the problems existing in the operation of medical services in China, the queuing theory is applied from the perspective of hospital facilities and staffing. System simulation and integer programming are used to study the strategies to reduce the cost of disease.
【学位授予单位】：天津大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R197.32

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