摘要
目的探讨适合本地区急性心肌梗死患者的DRGs分组方案及费用标准,为控制住院费用和诊断相关组-预付费制度(DRGs-PPS)在本地的试点实施提供依据。方法收集2017年1月1日-2019年12月31日新疆某三甲医院2554例急性心肌梗死出院患者病案首页资料,通过单因素分析和多元线性回归分析的结果筛选出分节点变量,运用决策树模型构建急性心肌梗死病例组合方案,制定各组合标准住院费用及病种权重。结果急性心肌梗死患者次均住院费用49297.75元;将多元线性回归分析中结果具有统计学意义的因素纳入决策树模型,即治疗方式、住院天数、入院途径作为急性心肌梗死病例分节点变量,建立了9个DRGs组及相对应的住院费用标准;对病例进行分组效果评价,各病例组合显示P<0.01,说明9个分组住院费用差异具有统计学意义,各组间异质性较好,分组较合理;超标总例数为63例,占研究总例数的2.5%,线外资源消耗比为4.7%。结论分组效果评价显示病例组合分组合理,且构建DRGs分组方案能够有效控制该病种的住院费用,为符合实际的本地区的实施提供依据。
Objectives To explore the grouping scheme and cost standard of DRGs suitable for patients with acute myocardial infarction in this area,and to provide basis for controlling hospitalization expenses and implementing prepaid system for diagnosis related groups in local pilot.Methods Through the results of single factor analysis and multiple linear Return analysis,the node variables were selected,and the combination scheme of acute myocardial infarction cases was constructed by using decision tree model,and the standard hospitalization expenses and disease weight of each combination were established.Results The average hospitalization cost of patients with acute myocardial infarction was 49297.75 yuan;The factors with statistical significance in multiple linear regression analysis were included in the decision tree model,that is,treatment mode,hospitalization days and admission route were taken as node variables of acute myocardial infarction cases,and 9 DRGs groups and corresponding hospitalization expense standards were established.The effect of grouping cases was evaluated,and each case combination showed P<0.01,which showed that the difference of hospitalization expenses among the nine groups was statistically significant,and the heterogeneity among the groups was good and the grouping was reasonable;The total number of cases exceeding the standard was 63,accounting for 2.5% of the total number of cases studied,and the consumption ratio of off-line resources was 4.7%.Conclusions The evaluation of the grouping effect showed that the case mix was reasonable,and the construction of the DRGs grouping scheme could effectively control the hospitalization expenses of the disease,which provided a basis for the actual implementation of DRGs-PPS in this region.
作者
孙菲
韩俊洋
张文倩
刘才华
卢武红
Sun Fei;Han Junyang;Zhang Wenqian;Liu Caihua;Lu Wuhong(School of Public Health,Xinjiang Medical University,Urumqi 830011,Xinjiang Uygur Autonomous Region,China;不详)
出处
《中国病案》
2021年第3期75-79,共5页
Chinese Medical Record
关键词
疾病诊断相关分组
急性心肌梗死
决策树
Diagnosis Related Groups
Acute Myocardial Infarction
Decision tree
