Objective:Aiming at the problems of clinical pathway optimization and medical cost control for stroke patients,this study proposes a clinical pathway discrimination model based on the XGBoost integrated learning algor...Objective:Aiming at the problems of clinical pathway optimization and medical cost control for stroke patients,this study proposes a clinical pathway discrimination model based on the XGBoost integrated learning algorithm.Combined with the multi-objective programming(MOP)method,this study explores its application value under the Diagnosis-Intervention Packet(DIP)payment model.Methods:The data of stroke patients(ICD codes I60-I63)from 2018 to 2024 were obtained through the medical record statistical management system of medical institutions in Guangdong Province.Efficiency indicators(average length of hospital stay),health economics indicators(total cost),effectiveness indicators(mortality rate),and specific indicators(NIHSS score)were extracted.The XGBoost algorithm was used to construct the clinical pathway discrimination model,and the hyperparameters were optimized through grid search.Based on the DIP payment rules,the prediction results of the model were used as inputs to establish a dynamic programming model,aiming to minimize costs and maximize curative effects to obtain the optimal clinical pathway plan.Results:The goodness-of-fit(R 2)of the XGBoost model on the test set reached 0.768,which was significantly better than that of the random forest(0.691)and the BP neural network(0.343).The total cost of the clinical pathway optimized by the dynamic programming model decreased by 12.7%(95%CI:10.2-15.1%),the average length of hospital stay was shortened by 1.8 days,and the NIHSS improvement rate increased by 8.3%.Conclusion:The integrated model proposed in this study has high accuracy and robustness in clinical pathway discrimination.Combined with the MOP method,it can provide a scientific basis for the optimization of medical resources under the DIP model,helping medical institutions achieve the dual goals of precise cost control and curative effect improvement.展开更多
Objective:This study aims to explore the benefit analysis of the same disease in different departments of public hospitals under the DIP payment method.Methods:This study is a retrospective analysis that selected clin...Objective:This study aims to explore the benefit analysis of the same disease in different departments of public hospitals under the DIP payment method.Methods:This study is a retrospective analysis that selected clinical data from patients who received treatment in the Department of Orthopedics and the Department of Acupuncture and Moxibustion at our hospital from January 1,2023,to December 31,2023.The study compared the costs of medications,examinations,treatments,laboratory tests,nursing and other expenses,and total treatment costs between the two departments.It analyzed the cost structure of the two departments and proposed further improvement suggestions.Results:The study results indicated that the total costs in the Department of Acupuncture and Moxibustion were significantly higher than those in the Department of Orthopedics.Among medication costs,the total medication costs in the Department of Orthopedics were higher than those in the Department of Acupuncture and Moxibustion,with costs for Western medicine,proprietary Chinese medicine,and herbal medicine all being higher(p<0.05).Regarding examination costs,consultation fees in the Department of Orthopedics were lower than those in the Department of Acupuncture and Moxibustion,while examination costs were higher(p<0.05).In terms of treatment costs,orthopedic treatment and surgical fees were higher than those in the Department of Acupuncture and Moxibustion(p<0.05).For laboratory test costs,orthopedic laboratory fees were significantly higher than those in the Department of Acupuncture and Moxibustion(p<0.05).Among nursing and other expenses,orthopedic blood transfusion,bed fees,and other expenses were higher than those in the Department of Acupuncture and Moxibustion,while nursing fees were lower(p<0.05).Conclusion:Treatment fees in the Department of Acupuncture and Moxibustion are the core and account for a relatively high proportion of the total costs.The benefits generated by the Department of Orthopedics are primarily derived from medication,examination,and laboratory fees,aligning with the characteristics of combining diagnosis,medication,and surgical intervention in orthopedic treatment.Consultation fees,nursing fees,and bed fees in the Department of Acupuncture and Moxibustion are higher than those in the Department of Orthopedics,indicating a longer treatment cycle in acupuncture,which warrants clinical attention.展开更多
基金Guangdong Medical Science and Technology Research Fund,Research on the Construction of a Clinical Path Discrimination Model for Stroke Patients Based on the XGBoost Integrated Learning Algorithm and Its Application in MOP under the DIP Payment Model,(Project No.:B2023177)Guangdong Health Economics Association,Research on the Prediction of Hospitalization Costs of Stroke Patients under the DRG/DIP Reform Based on Machine Learning Algorithms,(Project No.:2022-WJMF-13)。
文摘Objective:Aiming at the problems of clinical pathway optimization and medical cost control for stroke patients,this study proposes a clinical pathway discrimination model based on the XGBoost integrated learning algorithm.Combined with the multi-objective programming(MOP)method,this study explores its application value under the Diagnosis-Intervention Packet(DIP)payment model.Methods:The data of stroke patients(ICD codes I60-I63)from 2018 to 2024 were obtained through the medical record statistical management system of medical institutions in Guangdong Province.Efficiency indicators(average length of hospital stay),health economics indicators(total cost),effectiveness indicators(mortality rate),and specific indicators(NIHSS score)were extracted.The XGBoost algorithm was used to construct the clinical pathway discrimination model,and the hyperparameters were optimized through grid search.Based on the DIP payment rules,the prediction results of the model were used as inputs to establish a dynamic programming model,aiming to minimize costs and maximize curative effects to obtain the optimal clinical pathway plan.Results:The goodness-of-fit(R 2)of the XGBoost model on the test set reached 0.768,which was significantly better than that of the random forest(0.691)and the BP neural network(0.343).The total cost of the clinical pathway optimized by the dynamic programming model decreased by 12.7%(95%CI:10.2-15.1%),the average length of hospital stay was shortened by 1.8 days,and the NIHSS improvement rate increased by 8.3%.Conclusion:The integrated model proposed in this study has high accuracy and robustness in clinical pathway discrimination.Combined with the MOP method,it can provide a scientific basis for the optimization of medical resources under the DIP model,helping medical institutions achieve the dual goals of precise cost control and curative effect improvement.
文摘Objective:This study aims to explore the benefit analysis of the same disease in different departments of public hospitals under the DIP payment method.Methods:This study is a retrospective analysis that selected clinical data from patients who received treatment in the Department of Orthopedics and the Department of Acupuncture and Moxibustion at our hospital from January 1,2023,to December 31,2023.The study compared the costs of medications,examinations,treatments,laboratory tests,nursing and other expenses,and total treatment costs between the two departments.It analyzed the cost structure of the two departments and proposed further improvement suggestions.Results:The study results indicated that the total costs in the Department of Acupuncture and Moxibustion were significantly higher than those in the Department of Orthopedics.Among medication costs,the total medication costs in the Department of Orthopedics were higher than those in the Department of Acupuncture and Moxibustion,with costs for Western medicine,proprietary Chinese medicine,and herbal medicine all being higher(p<0.05).Regarding examination costs,consultation fees in the Department of Orthopedics were lower than those in the Department of Acupuncture and Moxibustion,while examination costs were higher(p<0.05).In terms of treatment costs,orthopedic treatment and surgical fees were higher than those in the Department of Acupuncture and Moxibustion(p<0.05).For laboratory test costs,orthopedic laboratory fees were significantly higher than those in the Department of Acupuncture and Moxibustion(p<0.05).Among nursing and other expenses,orthopedic blood transfusion,bed fees,and other expenses were higher than those in the Department of Acupuncture and Moxibustion,while nursing fees were lower(p<0.05).Conclusion:Treatment fees in the Department of Acupuncture and Moxibustion are the core and account for a relatively high proportion of the total costs.The benefits generated by the Department of Orthopedics are primarily derived from medication,examination,and laboratory fees,aligning with the characteristics of combining diagnosis,medication,and surgical intervention in orthopedic treatment.Consultation fees,nursing fees,and bed fees in the Department of Acupuncture and Moxibustion are higher than those in the Department of Orthopedics,indicating a longer treatment cycle in acupuncture,which warrants clinical attention.
