摘要
目的:探索胎膜早破患者按病种分值付费(DIP)分组方案及费用标准,为优化该病种细分组方案及提高医院精细化管理水平提供依据。方法:收集深圳市某地区两家二级医院2019—2021年主要诊断为胎膜早破出院患者1051例病案首页信息,利用单因素分析和多元线性回归分析影响住院费用的因素,采用决策树模型卡方自动交互检测算法(CHAID)建立胎膜早破病例组合方案并进行各组费用测算。结果:以手术操作为粗分组分类节点,根据多元线性回归结果将住院天数(t=14.465,P<0.001)和付费方式(t=-9.166,P<0.001)作为住院费用的主要影响因素纳入到细分组分类节点构建DIP分组决策树模型,最终共形成9个组内同质性强[各组变异系数(CV)值均小于0.3]、组间异质性大(χ^(2)=519.346,P<0.001)的DIP细组及相应的费用标准。结论:采用决策树模型,并综合考虑治疗操作及患者个体特征进行分组后的病例组合符合临床诊疗实际,分组具有一定合理性,可为相关部门优化该病种的细分组方案提供参考;DIP细分组可为医院基金分配及构建绩效考核评价体系等提供决策依据。
Objective:To explore the grouping of diagnosis-intervention packet(DIP)and cost standard of hospitalization expenses in patients with premature rupture of membranes(PROM),so as to provide a basis for optimizing the scheme of the disease category grouping and improving the level of hospital refined management.Methods:The first page information of 1051 medical records of discharged patients with premature rupture of membranes from two secondary hospitals in a district of Shenzhen from 2019 to 2021 was collected,and the influencing factors of hospitalization expenses were analyzed by single factor analysis and multiple linear regression.The chi-squared automatic interaction detection(CHAID)algorithm for decision tree models was used to establish the case-mix scheme of premature rupture of membranes and calculate the expenses of each group.Results:The classification node was roughly grouped by surgical operation.Based on the results of multiple linear regression,the length of hospital stay(t=14.465,P<0.001)and the payment method(t=-9.166,P<0.001)were included as the main influencing factors of hospitalization expenses into the sub-group classi fication node to build the DIP group decision tree model,and finally formed a total of 9 DIP subgroups and corresponding cost standards with strong inter-group homogeneity[coefficient of variation(CV)of each group was less than 0.3]and great inter-group heterogeneity(χ^(2)=519.346,P<0.001).Conclusion:The case combinations after grouping based on the decision tree model and comprehensive consideration of the treatment operation and individual characteristics of patients is in line with the clinical diagnosis and treatment practice,and the grouping is reasonable,which can provide reference for the relevant departments to optimize the detailed grouping method of the disease;DIP subgroups can provide decision-making basis for hospital fund allocation and construction of performance evaluation system.
作者
罗小霞
刘新靓
董四平
张志彬
梁进
李准
黎浩
Luo Xiaoxia;Liu Xinliang;Dong Siping;Zhang Zhibin;Liang Jin;Li Zhun;Li Hao(School of Public Health,Wuhan University,Wuhan 430071,China;School of Health Sciences,The University of Manchester,Manchester M139PL,the United Kingdom;National Institution of Hospital Administration,National Health Commission,Beijing 100044,China;The Pingshan District People’s Hospital of Shenzhen City,Shenzhen 518118,China;Pingshan Maternal and Child Health Hospital of Shenzhen City,Shenzhen 518122,China)
出处
《广西医科大学学报》
CAS
2023年第4期682-689,共8页
Journal of Guangxi Medical University
基金
深圳市坪山区卫生科研项目(No.202035)。
关键词
按病种分值付费
决策树
胎膜早破
住院费用
病例组合
diagnosis-intervention packet
decision tree
premature rupture of membranes
hospitalization expenses
case-mix
作者简介
通信作者:李准,E-mail:530191600@qq.com;通信作者:黎浩,E-mail:h.li@whu.edu.cn。
