基于疾病诊断相关分组方案对精神分裂症患者住院费用初步探究
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摘要
目的通过合理分组,制定精神分裂症患者住院费用发生额度的参考范围,为实现医保基金的合理使用与监管提供决策依据。方法以疾病诊断相关分组(diagnosis related groups,DRGs)核心思想为指导,采用决策树分析的卡方自动交互检测法(Chi-square automatic interaction detection,CHAID)算法,对患者进行细化分组并制定医疗费用合理范围。结果 (1)最终医院级别、住院天数、曾住院次数被用作截断点变量,生成一棵总节点数为21,终节点数为13,树深为3的决策树统计模型。(2)全部病例共形成13个病例组合,共筛选出1 096例可疑案例,构成比为10.03%,发生费用占总发生费用的21.60%(7 165 046.09/33 171 509.68);超额费用占发生费用的24.74%(1 772 930.71/7 166 251.86),占总发生费用的5.34%(1 772 930.71/33 171 509.68)。结论将DRGs方案应用于本病种,通过将患者合理分组来研究住院费用问题可为医疗保险基金的合理使用和监管提供一条可循的管理路径。
Objective To figure out a reasonable reference range of hospitalization expenses of patients with schizophrenia by means of creating special groups with statistic models and to propose reference for the use and monitor medical insure funds. Methods Chi-square automatic interaction detection(CHAID)and decision tree were used to generate diagnosis-related groups to designate confidence interval of hospitalization expenses. Results A total of 21 nodes were achieved from the 3-depth decision tree with 13 final nodes.A total of1 096 abnormal cases were screened accounting for 10.03% of the training samples with the total cost accounting for 21.60%(7 165 046.09/33 171 509.68)of the whole cost and the over-the-limit cost accounting for24.74%(1 772 930.71/7 166 251.86)of their total cost and 5.34%(1 772 930.71/33 171 509.68)of the whole cost. Conclusions DRGs proposal provides an effective way to monitor the use of medical insure funds for patients with schizophrenic.
Objective To figure out a reasonable reference range of hospitalization expenses of patients with schizophrenia by means of creating special groups with statistic models and to propose reference for the use and monitor medical insure funds. Methods Chi-square automatic interaction detection(CHAID)and decision tree were used to generate diagnosis-related groups to designate confidence interval of hospitalization expenses. Results A total of 21 nodes were achieved from the 3-depth decision tree with 13 final nodes.A total of1 096 abnormal cases were screened accounting for 10.03% of the training samples with the total cost accounting for 21.60%(7 165 046.09/33 171 509.68)of the whole cost and the over-the-limit cost accounting for24.74%(1 772 930.71/7 166 251.86)of their total cost and 5.34%(1 772 930.71/33 171 509.68)of the whole cost. Conclusions DRGs proposal provides an effective way to monitor the use of medical insure funds for patients with schizophrenic.
引文
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[10]高子厚,万崇华,蔡乐,等.按DRGs组合方式制定消化系统疾病患者住院费用的研究[J].中国卫生统计,2006,23(4):323-325.
[11]Foil C,Pecci G,Galliani M,et al.IgA nephropathy multivariate statistical analysis aimed at predicting outcome[J].J Nephrol,2001,14(4):280-285.
[12]Quentin W,Rtto H,Peltola M,et al.Acute myocardial infarction and diagnosis-related groups:patient classification and hospital reimbursement in 11 European countries[J].Eur Heart J,2013,34(26):1972-81.
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[2]Cuckler GA,Sisko AM,Keehan SP,et al.National health expenditure projections,2012-22:slow growth until coverage expands and economy improves[J].Health Aff(Millwood),2013,32(10):1820-1831.
[3]李君荣,李孝叶,马方.卫生费用适度合理增长的探讨[J].中国卫生经济,2013,32(3):17-19.
[4]Jang JS,Shin DG,Cho HM,et al.Differences in the survival of gastric cancer patients after gastrectomy according to the medical insurance status[J].J Gastric Cancer,2013,13(4):247-254.
[5]Goldfield N.The evolution of diagnosis-related groups(DRGs):from its beginnings in case-mix and resource use theory,to its implementation for payment and now for its current utilization for quality within and outside the hospital[J].Qual Manag Health Care,2010,19(1):3-16.
[6]Lang HC,Su TP.The cost of schizophrenia treatment in Taiwan[J].Psychiatr Serv,2004,55(8):928-930.
[7]Andlin-Sobocki P,Jonsson B,Wittchen HU,et al.Cost of disorders of the brain in Europe[J].Eur J Neurol,2005,12(Suppll):1-27.
[8]中华医学会精神科分会.中国精神障碍分类与诊断标准[M].3版.济南:山东科技出版社,2001:75-77.
[9]Murphy EL,Comiskey CM.Using chi-squared automatic interaction detection(CHAID)modelling to identify groups of methadone treatment clients experiencing significantly poorer treatment outcomes[J].J Subst Abuse Treat,2013,45(4):343-349.
[10]高子厚,万崇华,蔡乐,等.按DRGs组合方式制定消化系统疾病患者住院费用的研究[J].中国卫生统计,2006,23(4):323-325.
[11]Foil C,Pecci G,Galliani M,et al.IgA nephropathy multivariate statistical analysis aimed at predicting outcome[J].J Nephrol,2001,14(4):280-285.
[12]Quentin W,Rtto H,Peltola M,et al.Acute myocardial infarction and diagnosis-related groups:patient classification and hospital reimbursement in 11 European countries[J].Eur Heart J,2013,34(26):1972-81.
[13]Mathauer I,Wittenbecher F.Hospital payment systems based on diagnosis-related groups:experiences in low-and middle-income countries[J].Bull World Health Organ,2013,91(10):746-756A.