胃癌患者住院费用的DRGs病例组合研究

Case-Mix Analysis and Diagnosis-related Groups(DRGs)among Patients with Gastric Cancer

目的:探索适合南通市胃癌患者的病例诊断组合相关组(DRGs)及费用标准。方法:利用南通市肿瘤医院2006年—2013年以胃癌为主要诊断的5 771例病案首页数据,运用CHAID决策树方法进行病例分组,用变异系数(CV)于模型效度的组内同质性、方差减少量(RIV)对组间异质性进行评价,用绝对值法和相对权重法测算住院费用的相关标准。结果:胃癌患者住院费用的均数为16 896元,中位住院天数10天。治疗方法、首次入院、入院途径、转归、并发证、年龄等作为胃癌病例分类节点的关键变量,共形成13个DRGs组合。结论:病例分组结果合理,住院费用标准及病种权重可为医保部门制定支付标准提供参考。

Objectives:To explore the case-mix method in diagnosis-related groups(DRGs)and cost standard for the patients with gastric cancer in Nantong city.Methods:The first-page medical records of 5 771 cases of gastric cancer mainly diagnosed from 2006 to 2013 in Nantong cancer hospital were grouped by the decision tree model based on the CHAID algorithms.Validity in terms of homogeneity within groups and heterogeneity between groups was measured by coefficient of variance(CV)and reduction of variance(RIV).The absolute value method and relative weights were used to calculate the standard.Results:The mean hospitalization expense was 16896 Yuan,and the median length of stay(LOS)was ten days.The main classification node variableswere therapies,first hospitalization,hospital admission approaches,prognosis,complication,and age.13 diagnosis-related-groups and related health expense standards were established.Conclusion:Case-mix diagnosis-related groups are reasonable,and the health expense standards and related case weight could make references for health insurance department to formulate the payment standard.