晚期慢性肾脏病住院患者疾病诊断相关分组的初步研究——以成都市某三甲医院为例

Preliminary study of Diagnosis Related Groups for inpatients with advanced chronic kidney disease—take a grade-A tertiary hospital in Chengdu as an example

[目的]探讨晚期慢性肾脏病住院患者的疾病诊断相关分组方案并制定住院费用标准。[方法]采集成都市某三甲医院2018-2022年4~5期慢性肾脏病患者的住院诊疗数据,采用非参数检验、多元线性回归、人工神经网络筛选出住院费用的主要影响因素,选用E-CHAID算法建立病例分组方案后,经5折交叉验证将样本分为训练集和测试集评估疾病分组效果并计算参考费用。[结果]2987例病例中,晚期慢性肾脏病患者平均住院费用为13429元;以住院天数、有无透析治疗、有无合并症或并发症3个因素作为决策树E-CHAID分类节点,形成7个疾病诊断相关分组及相应住院费用标准;对病例进行分组效果评价,在测试集和训练集上变异系数CV均<0.8,表明组内同质性较好。[结论]运用E-CHAID算法对晚期慢性肾脏病患者进行分组符合临床实际,可为合理控制该类住院患者医疗费用提供依据,同时为推进医疗保险支付改革提供参考。

Objective To explore the Diagnosis Related Groups scheme for inpatients with advanced chronic kidney disease and to develop standards of hospitalization cost.Methods The diagnosis and treatment data of inpatients with stage four to five chronic kidney disease were collected in a tertiary hospital in Chengdu from 2018 to 2022.Nonparametric tests,multiple linear regression,and artificial neural network were used to screen out the main influencing factors of hospitalization cost.After a grouping scheme of case was established through the E-CHAID algorithm,the samples were divided into a training set and a test set by a 5-fold cross-validation to assess the effect of disease grouping and calculate the reference cost.Results Among the 2987 cases,the average hospitalization cost of patients with advanced chronic kidney disease was 13429 yuan.Three factors,length of stay,whether there was dialysis treatment,whether there was comorbidities or complications,were taken as classification nodes of the decision tree E-CHAID to form seven Diagnosis Related Groups and the corresponding standards of hospitalization cost.The grouping effect of the cases was evaluated,and the coefficient of variation(CV)was lower than 0.8 in both the test set and the training set,indicating good homogeneity within the group.Conclusions Grouping patients with advanced chronic kidney disease through E-CHAID algorithm is consistent with clinical practice,which provides a basis for rational control of the medical cost of such inpatients,and provides a reference for promoting the reform of medical insurance payment.