基于关联规则的DRG病组医用耗材使用评价方法研究

Association rule-based research on medical consumables usage of DRG patient groups

目的:基于关联规则探索疾病诊断相关分组(diagnosis related group,DRG)高值医用耗材临床合理使用评价方法,为高值医用耗材临床合理使用监管提供参考。方法:以心血管内科为例,首先,运用K-means算法对科室DRG病案进行聚类分析,选出具有代表性的病案作为研究对象;其次,运用Apriori算法挖掘心血管内科DRG病组、高值医用耗材频繁项集以及DRG病组和医用耗材关联规则;最后,设计医用耗材监管重要度和使用合理性2项指标对高值医用耗材的监管重要度和使用合理性进行评价。结果:心血管内科常见的DRG病组为FM39(经皮心导管检查操作)和FM19(经皮冠状动脉支架植入),2个病组常用的医用耗材包括血管鞘、造影导管、压力监测套件、三联三通和冠脉导引导丝。FM39病组医用耗材使用常见组合为血管鞘、造影导管、压力监测套件、三联三通、冠脉导引导丝,与心血管内科整体接近;FM19病组医用耗材使用常见组合在FM39病组的基础上新增关闭器、冠脉导引导管、压力泵、药物洗脱支架和冠脉扩张球囊。监管重要度排名前三的医用耗材为切割球囊、冠脉导引导丝和药物洗脱支架;以2022年1—9月的置信度为标准,2023年1—9月FM39病组对应高值医用耗材使用合理性超出标准5.08%,FM19病组低于标准9.23%。结论:基于关联规则的DRG病组医用耗材使用评价方法能够对高值医用耗材的监管重要度和使用合理性进行评价,可以为高值医用耗材合理使用监管提供参考。

Objective To explore the clinical rational use evaluation method for high-value medical consumables in diagnosis related groups(DRG)using association rules in order to provide references for the supervision of clinical rational use of high-value medical consumables.Methods The cardiovascular department was taken as an example.Firstly,K-means algorithm was applied to cluster analysis of DRG cases in the department,and representative cases were selected as the research objects;secondly,Apriori algorithm was used to mine the frequent item sets of DRG patient groups,the high-value medical consumables in the department and the rules of association between DRG patient groups and medical consumables;finally,two indicators of the importance of regulation and rationality of the use of medical consumables were designed to evaluate the importance of regulation and rationality of the use of high-value medical consumables.Results There were two common DRG patient groups in the cardiovascular department,including FM39 percutaneous cardiac catheterization and FM19 percutaneous coronary stent implantation,and the frequently used medical consumables contained vascular sheath,contrast catheter,pressure monitoring kit,triple three-way stopcock and coronary guide wire in the two groups.The common combinations of medical consumables used in the FM39 DRG patient group comprised of vascular sheath,contrast catheter,pressure monitoring kit,triple three-way stopcock and coronary guide wire,which were close to that of the cardiovascular department;there were some additional consumables involved in the common combinations in the FM19 group such as occluder,coronary guide catheter,pressure pump,drug-eluting stent and coronary dilation balloon.The top three medical consumables in terms of regulatory importance were cutting balloon,coronary guide wire and drug-eluting stent;using the confidence level from January to September 2022 as a reference,from January to September 2023 the rationality of using high-value consumables in FM39 group went higher by 5.08%while that in FM19 group went lower by 9.23%.Conclusion The association rule-based evaluation method for the use of medical consumables in DRG patient groups can be used for assessing the importance of regulation and rationality of the use of high-value medical consumables,which provides references for the supervision of clinical rational use of high-value medical consumables.