基于DRGs的心力衰竭患者住院费用标准研究

Research on the hospitalization expenses standard of patients withheart failure based on diagnosis related groups

[目的]探索心力衰竭(以下简称“心衰”)患者住院费用疾病诊断相关分组方案,为该病种住院费用标准的制定提供参考。[方法]收集山东省某三级甲等医院2016年1月1日-2020年12月31日主要诊断为心力衰竭(ICD-10编码前三位为I50)的住院患者信息。利用单因素分析和多元线性回归分析筛选出分类节点变量,运用CHAID决策树模型对心衰患者进行分组及费用测算。[结果]共纳入心衰住院患者760例,住院总费用中位数为13,881.87元。心衰等级为III-IV级或IV级、年龄≥65岁、进行手术治疗、并发症或合并症个数>7个的患者住院总费用较高(P<0.05)。经CHAID决策树分析,共得到6个病例组合,心衰等级III-IV级或IV级且行手术治疗的患者标准费用最高,为37,910.59元;心衰等级III级及以下且年龄<65岁的患者标准费用最低,为7749.10元。[结论]利用CHAID决策树模型进行心衰患者DRGs病例分组合理,费用标准可为本地区内医院和医保机构制定决策提供依据。

Objective To explore the disease diagnosis related grouping scheme of the hospitalization expenses in patients with heart failure so as to provide reference for making hospitalization expenses standard of the disease.Methods The information of inpatients who were mainly diagnosed with heart failure(I50 for the first three digits of ICD-10 code)from January 1,2016 to December 31,2020 were collected in a class A tertiary hospital in Shandong Province.Single factor analysis and multivariate linear regression analysis were used to screen out the classification node variables.The CHAID decision tree model was used to group patients with heart failure and calculate the expenses.Results A total of 760 hospitalized patients with heart failure were involved,the median total hospitalization expenses was 13,881.87 yuan.Total hospitalization expenses of patients with heart failure grade was III-IV or IV,65 years old,underwent operation,with 7 complications was higher(P<0.05).Through CHAID decision tree analysis,a total of 6 case combinations were obtained.The hospitalization expenses standard of patients with heart failure grade III-IV or IV and underwent operation was the highest(37,910.59 yuan);The hospitalization expenses standard for patients with heart failure grade III and whose age 65 years old was the lowest cost(7,749.10 yuan).Conclusions The DRGs case grouping by CHAID decision tree model for patients with heart failure is reasonable.And the hospitalization expenses standard can provide reference for the decision-making of hospitals and medical insurance institutions in local region.