基于DRGs的呼吸系统疾病住院费用分析

DRGs-based expense analysis of inpatients with respiratory system diseases

目的为合理确定呼吸系统疾病的诊断相关组费用标准提供数据依据。方法以某院19285例呼吸系统疾病住院病历首页资料为样本，运用决策树模型中卡方自动交叉诊断法形成呼吸系统疾病住院患者病例组合方案，并采用方差减少量检验模型效果。结果呼吸系统疾病患者住院费用中位数为1603．97元，平均数为2806．03元，离散程度大。呼吸系统疾病住院治疗者实施手术的比例较少，为3．89％，年龄是呼吸系统疾病住院费用的重要影响因素。呼吸系统疾病住院患者病例组合方案的分类节点依次为出院第一诊断、年龄、次要诊断，这些节点将患者分为5个疾病类别、29个诊断相关组。结论适宜的出院诊断是构建诊断相关组的基础，呼吸系统疾病的分类变量宜选用年龄、次要诊断等与疾病严重程度相关的变量。

Objective To reasonably provide data basis of the expense standard for diagnosis related groups（DRGs）of respiratory system disease. Methods Use the first-page data of the medical records of 19,285 respiratory inpatients of a hospital. Use the Chi-squared Automatic Interaction Detector in the decision tree model to establish the inpatient case mix plan of respiratory disease inpatients. Then evaluate the model effectiveness with the variance reduction Results Expense median of the respiratory disease inpatients is 1603.97 yuan,averaging 2806.03 yuan,and the discretion degree is high. Proportion of surgical operations in respiratory disease is 3.89 ~, less than the others. Age is an important factor of respiratory disease for their hospitalization costs. Classification nodes of respiratory diseases are in turn the first discharge diagnosis, age,and secondary diagnosis. Patients were divided into 5 categories and 29 disease diagnosis related groups by such nodes. Conclusion Appropriate discharge diagnosis is the basis for building diagnosis related groups. Such variables as disease severity related variables as age and secondary diagnosis should serve as classification variables for respiratory system diseases.