广义加性模型在医疗费用控制中的应用

The Application of Generalize Additive Models in Medical Cost Control

目的探讨广义加性模型对住院费用影响因素研究的可行性。方法从天津银海2003～2007年住院参保人群资料库中抽取诊断为白内障的5030例患者,采用S-PLUS6.2与SAS9.2对患者的住院费用进行广义加性模型拟合。结果该模型显示住院费用的影响因素有医院级别、参保年度、人员类别、年龄、住院天数与耗材比例,其中年龄、住院天数、耗材比例与住院费用呈复杂的非线性关系。结论广义加性模型不需要模型的线性假设、正态分布,且能够发现丰富的信息,应用灵活,是探索变量间复杂关系的有力工具。

Objective In order to probe the advantages and feasibility of Generalize Additive Models（GAM） being used to analyze the factors influencing hospitalization costs.Methods All information of Cataract patients were collected in Tianjin hospitals from January,2003 to December,2007.The data ware analyzed with GAM by using Professional statistical software S-PLUS6.2 and SAS9.2.Results GAM found the factors influencing hospitalization costs were days of hospitalization,rank of hospitalization,the insure year,the proportion of material costs,age and occupation.The structure of a smooth map of GAM found independent variables（days of hospitalization,the proportion of material costs,age） with outcome variables（total hospitalization costs） was not a linear relationship.Conclusion GAM does not assume a linear model,normal distribution,and can find a wealth of information.The advantages and feasibility of GAM can be further elaborated so that it can be used as a powerful tool to explore the complex relationships between variables.