CHS-DRG分组方案评价及优化研究——以恶性肿瘤药物治疗为例

Evaluation and Optimization of CHS-DRG Grouping Schemes Based on Drug Therapy of Cancer

目的:以恶性肿瘤药物治疗相关细分组为例,评估医疗保障疾病诊断相关分组(CHS-DRG)分组效果,研究优化病例分组方式,为合理制定DRG分组提供依据。方法:收集天津市某三级肿瘤专科医院CHS-DRG付费以来恶性肿瘤药物治疗相关的分组病例共27268例,采用变异系数(CV)、方差减少系数(RIV)等指标评价分组效果,利用结构变动度等方法评估住院费用的内部结构变动情况。通过回归分析筛选住院费用的影响因素,并基于决策树穷举的卡方自动交叉检验(E-CHAID)方法构建恶性肿瘤药物治疗优化分组方案,确定付费标准。结果:恶性肿瘤药物治疗相关的分组效能欠佳,通过构建决策树模型,以是否联合治疗、住院天数、是否应用新技术、年龄和是否存在肝肾心功能损伤作为显著影响患者住院费用的因素和分类节点优化分组,构建8个新分组及其住院费用标准。结论:基于决策树模型可以将病例合理分组并客观反映医疗资源消耗,可为将来恶性肿瘤药物治疗相关的分组调整以及推进门诊恶性肿瘤日间化疗支付方式改革提供参考依据。

Objective:Based on drug therapy of cancer,the paper attempts to evaluate the effect of CHS-DRG grouping,study the methods to optimize the grouping of cases,and provide a basis for the rational formulation of DRG grouping.Methods:A total of 27268 cases related to malignant tumor drug treatment since the payment of CHS-DRG reform from a tertiary cancer specialized hospital in Tianjin were collected.The grouping effect was evaluated with indicators such as coefficient of variation(CV)and reduction in variance(RIV).The internal structural changes of hospitalization expenses were evaluated with methods such as degree of structural change.The influencing factors of hospitalization expenses were screened through the regression analysis,and based on the decision tree E-CHAID method,we construct an optimized grouping plan for malignant tumor drug treatment and determine the payment standard.Results:The efficacy of CHS-DRG grouping in the treatment of malignant tumors was not good enough.By constructing a decision tree model,the factors and classification nodes that significantly affect the hospitalization cost of patients were identified according to the combination therapy,length of hospital stay,application of new technologies,age,and the presence of liver,kidney,and heart function damage.Eight new groups and their hospitalization cost standards were constructed.Conclusion:Based on the decision tree model,cases can be reasonably grouped and objectively reflect the consumption of medical resources,which can provide a reference for adjusting the DRG grouping of malignant tumor drug therapy in the future and promoting the reform of outpatient malignant tumor daytime chemotherapy payment methods.