基于决策树E-CHAID算法建立股骨颈骨折病例的DRGs分组

Research on the Diagnosis Related Groups of Patients with Femoral Neck Fracture Based on Decision Tree Model E-CHAID Algorithm

目的 探讨股骨颈骨折患者的疾病诊断相关分组方案和住院费用参考标准。方法 数据来源于山东省某三甲医院2016年1月1日-2020年12月31日1024例股骨颈骨折患者的住院病案首页信息,采用单因素分析和多元线性回归分析筛选分类节点变量,利用E-CHAID算法的决策树模型建立股骨颈骨折患者的DRGs分组方案,并计算各组费用标准和费用上线。结果 股骨颈骨折患者住院次均费用39 939.54元;治疗方式、住院天数、有无并发症/合并症作为分类节点变量纳入决策树模型,建立7个DRGs分组及相应的住院费用标准;经Kruskal-Wallis H检验各组住院费用差异有统计学意义(P<0.001),RIV值为60.51%、变异系数CV为0.15-0.53。结论 基于决策树模型E-CHAID算法建立的股骨颈骨折病例分组合理,分组方案及住院费用标准可为医疗机构合理控费、提高医疗质量与效率提供依据,同时为本地区开展DRGs医保付费提供参考。

Objective To explore the scheme in diagnosis related groups(DRGs) and standard of hospitalization expenses for patients with femoral neck fracture. Methods The medical records of 1024 patients with femoral neck fracture in a tertiary hospital of Shandong Province form January 1st, 2016 to December 31st, 2020 were extracted.Nonparametric test and multiple linear regression were used to screen the categorized node variables. The E-CHAID of decision tree model was used to establish the case mixed scheme for patients with femoral neck fracture. The standard expenses and the expenses limit were calculated. Results The average hospitalization cost of patients with femoral neck fracture was 39939.54 yuan. The therapy method, length of stay, complication and comorbidity were taken as classification node variables and incorporated into the decision tree model. 7 diagnosis related groups and the corresponding hospitalization expense standards were established. There were statistically significant differences in hospitalization expenses among each groups by Kruskal-Wallis H test(P<0.001). Reduction in variance(RIV) was 60.51%, coefficient of variation(CV) was 0.15-0.53. Conclusions The grouping of femoral neck fracture cases based on decision tree model E-CHAID algorithm was reasonable. The case-mixed model and the standard of hospitalization expenses could provide references for medical institutions to reasonably control medical expenses, improve the quality and efficiency of medical treatment, and for the promotion of DRGs payment and relevant policy formulation in this area.