摘要
目的探索不稳定型心绞痛患者住院费用疾病诊断相关分组方案,为控制住院费用提供参考。方法收集广东省某三级甲等医院2021年1月1日-2022年5月31日主要诊断为不稳定型心绞痛的住院患者信息。利用单因素分析和多元线性回归分析筛选出分类节点变量,运用CHAID决策树模型对不稳定型心绞痛患者进行分组及费用测算。结果共纳入不稳定型心绞痛住院患者1026例,中位住院总费用为15201.00元。住院天数、是否手术、性别作为分类节点变量进入了决策树模型,病例组合的CV在0.4到0.55之间,说明组内差异小;RIV为53.268%,说明组间异质性强。最终共形成8个费用组合,包括4个无手术组和4个有手术组。基于组合结果得到无手术组住院费用标准4554-11522元,有手术组住院费用标准14918-23761元,病种权重在0.4-2.2之间,无手术组存在费用超限的情况。结论病例组合结果合理,基于决策树得到的病例组合可以提供住院费用标准、病种权重、线外费用标准,有利于控制该病种的住院费用,减轻患者经济负担,为医疗费用支付方式改革提供一定的参考。
Objectives To explore the grouping scheme of disease diagnosis related to hospitalization expenses of patients with unstable angina pectoris,so as to provide reference for controlling hospitalization expenses.Methods The information of inpatients with unstable angina pectoris was collected from January 1st,2021 to May 31st,2022 in a Three A and Tertiary Hospital in Guangdong Province.Single factor analysis and multiple linear regression analysis were used to select the classification node variables,and CHAID decision tree model was used to group patients and calculate the cost.Results A total of 1026 hospitalized patients with unstable angina pectoris were included,and the median total hospitalization cost was 15201.00 yuan.The number of days in hospital,whether to operate or not,and gender entered the decision tree model as classification node variables.The CV of the case mix was between 0.4 and 0.55,indicating that the difference within the group was small;RIV was 53.268%,indicating strong heterogeneity between groups.Finally,8 cost groups were formed,including 4 non operation groups and 4 operation groups.Based on the combination results,the hospitalization expense standard of the non-operating group was 4554-11522 yuan,and the hospitalization expense standard of the operating group was 14918-23761 yuan.The disease category weight was 0.4-2.2,and the cost of the non-operation group exceeded the upper limit of cost control.Conclusions The grouping of cases was reasonable.The cost group obtained based on the decision tree could provide hospitalization expense standard,disease relative weight,and offline expense standard,which was conducive to controlling the hospitalization expense of the disease,reducing the economic burden of patients,and providing some reference for the reform of medical expense payment method.
作者
林卓琛
辛子艺
熊莺
Lin Zhuochen;Xin Ziyi;Xiong Ying(The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510000,Guangdong Province,China;不详)
出处
《中国病案》
2023年第8期60-64,共5页
Chinese Medical Record
关键词
不稳定型心绞痛
CHAID决策树
住院费用
Unstable angina pectoris
CHAID decision tree
Hospitalization expenses
