摘要
目的探索按病例组合付费,疾病诊断相关分组(diagnosis-related group,DRG)的细分组方法,为制定DRG分组合理补偿机制、标准和院内病种成本核算以及绩效考核提供依据。方法纳入复旦大学附属妇产科医院2019年-2021年共17010例子宫肌瘤住院患者的病案首页数据,以疾病和治疗方式为基础,结合住院天数、其他诊断等,采用非参数检验和广义线性模型方法分析影响住院费用的因素,利用决策树模型对子宫肌瘤住院患者进行分组及费用预测。结果决策树模型根据患者主要手术方式、其他手术类型、住院天数将子宫肌瘤患者分为13组,方差减少值为0.34,表示分组方法解释性较好;各组变异系数为0.19~0.88,均小于1,表示组内同质性较好。结论以决策树模型作为分组技术制定的病例组合支付方式更符合子宫肌瘤临床诊疗实际,可作为DRG病种细分组的方法学参考;DRG实施背景下医院可通过对DRG病种进行院内细分组,为院内成本核算、绩效分配等精细化管理提供决策依据。
Objective To explore the subdivision method of diagnosis-related group(DRG)by case-mix payment,and provide reference for reasonable imbursement mechanism and standard for DRG grouping,as well as disease cost accounting and performance assessment for hospitals.Methods The first page data of medical records of 17010 inpatients with uterine fibroids in Obstetrics and Gynecology Hospital of Fudan University from 2019 to 2021 were included.Based on the disease and treatment,combined with the length of hospital stay,other diagnosis and other factors,nonparametric test and generalized linear model were used to explore the factors affecting hospitalization expenses.Decision tree model was performed to yield case-mix related groups and predict the cost.Results The inpatients with uterine fibroids were classified into 13 groups in decision tree model based on the main surgical methods,other surgical types,and length of hospital stay.The reduction in variance was 0.34,and the coefficient of variation was 0.19-0.88.Conclusions The case-mix payment approach based on the decision tree model as the grouping method is more consistent with the actual clinical diagnosis and treatment of uterine fibroids,and can be used as method reference for the subdivision of DRG.Under the background of DRG,subdivision of DRG can provide decision-making basis for refined hospital management,including in-hospital cost accounting and performance allocation.
作者
余赟
董四平
陈春
苏毓
YU Yun;DONG Siping;CHEN Chun;SU Yu(Medical Record Department,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,P.R.China;National Institute of Hospital Administration,National Health Commission,Beijing 100044,P.R.China;Department of Gynecology,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,P.R.China;Information Department,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,P.R.China)
出处
《华西医学》
CAS
2022年第12期1772-1778,共7页
West China Medical Journal
基金
国家卫生健康委医院管理研究所项目(NIHA202011)。
关键词
疾病诊断相关分组
住院费用
病例组合
决策树
子宫肌瘤
Diagnosis-related group
hospitalization expense
case-mix
decision tree
uterine fibroids
