化疗患者住院费用的疾病诊断相关分组组合方式研究

A study of case mix scheme in drgs for hospitalization expenses of chemotherapy patients

目的 探讨化疗患者的诊断相关分组组合,制定化疗患者住院费用的参考标准,为实施符合江西省省情的付费制度提供参考。方法 收集江西省4家不同地区三甲医院2019—2020年52 136例化疗病例,采用非参数检验和神经网络对住院费用影响因素分析,明确住院费用的主要影响因素,再利用决策树法对化疗患者进行病例组合。结果DRG名称、肿瘤分期、肿瘤病种、年龄、住院天数是化疗患者住院费用的影响因素。化疗患者病例组合方案的分类节点依次为DRG名称、肿瘤分期、肿瘤病种、年龄,形成22个诊断相关分组和相对应住院费用标准。结论 通过增加肿瘤分期、肿瘤病种、年龄因素,进一步细化DRGs病例组合,组内变异较DRGs平台设计的分组更小,符合临床实际,据此制定化疗患者住院费用标准,可为医疗保险支付改革提供参考。

Objective To explore the case mix method in diagnosis-related groups for hospitalization expenses of chemotherapy patients,and to provide reference for implementing payment system in Jiangxi.Methods A total of 52,136 chemotherapy cases were collected from 4 grade A hospitals in different regions of Jiangxi during 2019 to 2020.The main factors determining the hospitalization costs were analyzed by non-parametric test and BP neural network methods,and DRGs combination of chemotherapy cases was established by using CHAID algorithm of decision tree model.Results Hospitalization expenses of chemotherapy patients were determined by DRG name,Cancer stage,cancer disease type,age and length of stay,based on which a total of 22 diagnosis-related groups and corresponding standard hospitalization expenses were formed.Conclusion The new intra group variation was smaller than that of the DRGs platform form case mix by increasing cancer stage,cancer disease type and age factors.It is in line with clinical practice.According to the standard of hospitalization cost of chemotherapy patients,it can provide reference for the reform of medical insurance payment.