基于CHAID算法的病毒性肝炎患者DRGs分组研究

发布时间：2018-04-11 17:35

本文选题：DRGs + 病例组合　；参考：《中国卫生统计》2015年03期

【摘要】：目的了解影响患者住院医疗费用的因素,建立DRGs病例分组并对各组医疗费用进行分析评价。方法以厦门地区病毒性肝炎患者为研究对象,首先利用单因素和多因素方法分析患者住院医疗费用的影响因素,然后以患者住院医疗费用作为目标变量,通过CHAID模型进行DRGs病例分组,最后采用RIV、CV等评价指标分析和评价分组结果。结果对可能影响住院医疗费用的变量进行单因素分析显示,年龄、付费方式、入院情况和是否手术4个因素具有统计学意义,通过多因素分析显示年龄、费用支付方式、入院情况是厦门地区肝炎患者住院费用的主要影响因素;进一步使用决策树CHAID模型分组得到3组该疾病的DRGs病例组合,第一组为自费方式的患者,第二组为具有医疗保险且入院情况为一般的患者,第三组为具有医疗保险且入院情况为紧急的患者。经非参数Kruskal-Wallis H检验、RIV值、变异系数评价,该病例组合方案具有较好的可靠性和合理性。各病例分组的标准费用分别为1984.73元、1359.23元与1874.68元。分析每个分组的费用门坎值,发现线外病人比例为6.47%~7.65%,却消耗了23.07%-30.09%的医疗费用。结论通过DRGs分组计算患者住院费用标准值可提供医疗保险机构的偿付参考值,自费病人的标准费用最高,其次是具有医疗保险且入院情况为紧急的患者,线外病人及其医疗消费应作为住院医疗费用总量控制重点。
[Abstract]:Objective to understand the influencing factors of hospitalization expenses of patients, analysis and evaluation of each medical expenses to establish DRGs and cases. Methods the patients with viral hepatitis in Xiamen area as the research object, firstly by using single factor and multi factor analysis method of hospitalization expenses of patients with influence factors, and then to hospital medical expenses of patients as the target variable. DRGs were grouped by CHAID model, finally using RIV, CV and other evaluation index analysis and evaluation. The grouping results univariate analysis showed that age, payment of medical expenses may affect the variables with statistical significance of 4 factors of hospitalization and surgery is, by multivariate analysis showed that age, payment. Admission is the main factors influencing hospitalization expenses of hepatitis patients in Xiamen area; the further use of CHAID decision tree model to the 3 packet group DRGs disease case mix, the first group is their own patients, second were with medical insurance and admission to the general group with third patients, medical insurance and admission to the emergency patients. The non parametric Kruskal-Wallis H test, RIV value, coefficient of variation of the evaluation, the case mix scheme has better the reliability and rationality. The standard expenses of each cases were 1984.73 yuan, 1359.23 yuan and 1874.68 yuan. The analysis of each packet cost threshold, found outside the line of patient ratio was 6.47%~7.65%, but the 23.07%-30.09% consumption of medical expenses. Conclusion the DRGs packet calculation hospitalization expense standard value can provide health insurance reimbursement reference value standard cost, private patients is the highest, followed by a medical insurance and admission to the emergency patients, patients and medical consumption line should be used as medical expenses Focus on total amount control.

【作者单位】：厦门大学公共卫生学院;福建省高校卫生技术评估重点实验室;厦门大学经济学院;
【基金】：国家自然科学基金青年项目(71403229) 教育部人文社会科学研究项目资助(12YJA790030) 福建省自然科学基金资助项目(2013J05108)
【分类号】：R512.6;R197.3

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