摘要
目的 评价病例组合对卒中病人住院费用的解释效果,为今后费用控制及采用疾病诊断相关分类(diagnosisrelatedgroups,DRGs)付费方式的实施提供统计学参考依据。方法 基于我国重庆两所医院1969例卒中病人资料,采用决策树模型分类与回归树算法(Classificationandregressiontrees,CART)形成我国卒中住院病人病例组合分类规则,并以国外卒中病人病例组合方案作为对照,建立卒中病人住院费用的多元统计模型,评价两种病例组合模型对卒中病人住院费用的解释效果。结果 ①我们建立的卒中住院病人病例组合方案的分类结点依次为有无手术、有无一级或特级护理及有无医院感染,这些结点将1969例卒中住院病人分为5组;而国外病例组合方案分类结点分别为外科手术、年龄、及本次出院后是否会到其它医疗机构,这些分类结点也将卒中住院病人分为5组。②针对我国第三方付费或医疗机构建立的组合方案,我们建立的病例组合方案各组标准总费用可解释80.46%的实际总费用,针对病人可解释16.58%住院费用;而国外病例组合方案的解释效果则分别为76.87%和9.13%。结论 相对于国外病例组合方案,我们建立的卒中住院病人病例组合方案更适合我国国情,但由于此结论仅基于1969例卒中住院病人的数据,故结论尚需要更多研究以证实。
Objective To Provide statistical references for disease based payment reform with Diagnosis Related Groups (DRGs).Methods Based on 1 969 stroke inpatients from two hospitals in Chongqing city, we used classification and regression trees (CART) of decision tree to establish classification regulations of the case mix model for stroke inpatients, and multivariate statistical model to evaluate whether the case mix could provide a satisfactory prediction to costs for stroke inpatients in comparison with the foreign model. Results ① The classification nodes of our model were surgical procedure, nursing care degree, and hospital infection respectively by which 1 969 stroke inpatients were divided into 5 groups. The classification nodes in foreign model were surgical procedure, age≥50 years, and whether patients would refer to other institutions after leaving the hospitals by which 1 969 stroke inpatients were also classified into 5 groups. ② For medical institutions and the third payers, we found that the data from our model could explain 80.46% of the total costs and 16.58% for individual inpatient, which were higher than that of foreign model (76.87% for medical institutions and the third payers, 9.13% for individuals ). Conclusions Compared with foreign model, our model is more suitable for the situation in China. The study is only based on 1 969 stroke inpatients from south west part of China, so the conclusion needs further studies to confirm .
出处
《中国循证医学杂志》
CSCD
2005年第1期42-46,85,共6页
Chinese Journal of Evidence-based Medicine
关键词
卒中
住院费用
病例组合
Stroke
Hospitalization costs
case-mix
