基于决策树的“椎管狭窄”DIP付费的并发症指数测算

Calculation of the complication index measurement for DIP payment based on decision tree for spinal stenosis

目的 探索DIP分组“椎管狭窄:腰椎椎体间融合术,后入路”的标准费用细分方案和并发症指数(CCI)测算,为医保部门完善DIP支付方案及政策制定提供参考。方法 选取广州市某大型三甲医院2020—2022年共1 610例“椎管狭窄”病例病案首页数据,筛选该病组的主要并发症,进一步采用决策树模型进行费用数据拟合,建立不同并发症的DIP细分组别,测算各组的并发症指数。结果 “椎管狭窄”病组的并发症主要由高血压、2型糖尿病、高尿酸血症和泌尿系感染,分别有20.31%、10.37%、5.16%和4.35%的病例发生这些并发症;分位数回归分析显示,是否有高血压、2型糖尿病、泌尿系感染或肺炎的2组病例之间,住院总费用存在统计学差异(P<0.05);基于决策树模型共形成4个“椎管狭窄”的DIP细分组别,具有“高血压”和“泌尿系感染”的细分组别并发症指数均为1.04,具有“2型糖尿病”并发症的细分组别并发症指数为1.08,其他并发症的细分组别并发症指数为0.98。结论 “椎管狭窄”的并发症病种分布广泛分散;运用决策树模型建立“椎管狭窄”细分方案标准费用和并发症指数测算,提高了DIP支付的精准度,可以点带面,为DIP制定细分方案和完善标准分值库提供参考依据。

Objective To explore the standard cost subdivision scheme and complication index measurement(CCI)of DIP subgroup"spinal stenosis:lumbar interbody fusion,posterior approach",and to provide reference for the improvement of DIP payment scheme and policy formulation by the medical insurance department.Methods The home page data of 1610 cases of spinal stenosis in a large tertiary hospital in Guangzhou from 2020 to 2022 were selected to screen the main complications of this group.The cost data were further fitted with decision tree model,DIP subgroups of different complications were established,and the complication index of each group was measured.Results The main complications in the spinal stenosis group were hypertension,type 2 diabetes,hyperuricemia and urinary system infection,which occurred in 20.31%,10.37%,5.16%and 4.35%cases,respectively.Quantile regression analysis showed that there were statistical differences in total hospitalization costs between the two groups with or without hypertension,type 2 diabetes,urinary tract infection or pneumonia(P<0.05).Four DIP subgroups with spinal stenosis were formed based on the decision tree model.The complication index of the subgroup with hypertension and urinary system infection was 1.04,that of the subgroup with type 2 diabetes was 1.08,and that of the subgroup with other complications was 0.98.Conclusion The complications of spinal stenosis are widely dispersed.The standard cost and complication index of spinal stenosis subdivision program are calculated by using decision tree model,which improves the accuracy of DIP payment and can provide reference for DIP to make subdivision program and improve the standard score database.