基于通径分析和决策树模型的异位妊娠手术患者病例组合研究

Case-Mix Study of Surgery Patients with Ectopic Pregnancy Based on Path Analysis and Decision Tree Model

目的:探索异位妊娠手术患者的病例组合方案及费用标准,为相关部门决策提供参考依据。方法:提取深圳市某三级甲等医院2013—2016年1 470例异位妊娠手术患者病历资料,采用通径分析筛选分类结点变量,运用决策树模型进行病例分组,计算各组合标准费用、警示费用、费用上限等指标。结果:异位妊娠手术患者病例组合的分类节点包括治疗方式、伴随病、病例分型、输血、抢救、并发症,共形成6个DRG组,各DRG组的组间异质性和组内同质性良好。结论:制定科学合理的病例组合及费用标准有利于控制医疗费用不合理上涨。

Objective: To explore the case-mix diagnosis-related-groups and cost criteria for surgery patients with ectopic pregnancy and provide references for the decision-making of relevant departments. Methods: The medical records of 1 470 surgery patients with ectopic pregnancy in a tertiary hospital of Shenzhen from 2013 to 2016 were extracted. Path analysis and decision tree model were used to screen the classification node variables, set up the case-mix diagnosis-related-groups and calculate the standard costs, warning fees, cost cap and other indicators for each group. Results: The classification node variables of the surgery patients with ectopic pregnancy included therapies, concomitant diseases, case type, blood transfusion, rescue and complications. A total of 6 DRG groups were formed, and the heterogeneity and homogeneity of each group were well. Conclusion: The establishment of scientific and reasonable case-mix diagnosis-related-groups and cost criteria were conducive to control the irrational increase of medical expenses.