基于决策树模型急性心肌梗死患者DRGs分组研究

Study on DRGs Grouping Patients with Acute Myocardial Infarction Based on Decision Tree Model

目的探索适合本地区基于决策树模型的DRGs分组方案及费用标准,应用DRGs定额偿付模式正向激励医疗支付过程标准化,促进费用控制和医院管理。方法采用多重logistic回归分析2016年1月至2018年8月3822例患者住院费用的影响因素,基于E-CHAID算法对急性心肌梗死患者进行DRCGs分组。结果患者年龄、住院天数、并发症合并症、手术情况四个变量纳入决策树模型(P<0.05),以是否具有支架植入作为第一个重要分类变量,共分为I11个DRGs组;不同DRGs组住院医疗费用差异有统计学意义,P<0.05;无支架植入且住院天数低于7天的两个组合线外费用超过5.00%。结论本次DRGs分组方案合理,建议加强本地区卫生信息化和标准化建设,制定符合地区实际的DRGs管理模式和合理偿付标准。

Objective To explore a DRGs grouping scheme and cost standard based on decision tree model.The application of the DRGs fixed-payment model positively stimulates the standardization of the medical payment process and promotes cost control and hospital management.Methods Multi-logistic regression was used to analyze the influencing factors of hospitalization expenses for 3822 patients from January 2016 to August 2018,and E-CHAID algorithm was used to group DRGs in patients with acute myocardial infarction.Results Four variables including patient age,days in hospital,complications,and whether surgery were included in the decision tree model(P<0.05).With the stent implantation as the first important categorical variable,it was divided into 11 DRGs groups.There was a statistically significant difference in hospitalization expenses between different DRGs groups,P<0.05,and the cost of the two groups without stent implantation and less than 7 days in hospital is more than 5.00%.Conclusions The DRGs grouping scheme is reasonable,it is recommended to strengthen the health informationization and standardization construction in the region,to formulate DRGs management model and reasonable reimbursement standards in line with regional realities.