子宫肌瘤患者住院费用的疾病诊断相关分组研究  

Study on The Diagnosis Related Group of Hospitalization Expenses of Uterine Myoma Patients

作　　者：林红梅[1] 夏桂玉[1] 柳旺艳 娄伟玲[1] 郑涛立 Lin Hongmei;Xia Guiyu;Liu Wangyan;Lou Weiling;Zheng Taoli(Medical Department,Health Department,Medical Record Department,Shaoxing Maternal and Child Health Hospital,Shaoxing 312000,Zhejiang Province,China;不详)

机构地区：[1]绍兴市妇幼保健院医务科、保健部、病案室,浙江省绍兴市312000

出　　处：《中国病案》2020年第6期30-33,共4页Chinese Medical Record

基　　金：绍兴市卫生计生科技计划项目(2017CX011)。

摘　　要：目的研究绍兴地区子宫肌瘤住院患者的DRG组合方案,制定子宫肌瘤患者住院费用的参考标准。方法收集2014年1月1日—2016年12月31日绍兴地区3家医院住院病案首页管理系统中以子宫肌瘤为主要出院诊断的3623例患者住院信息,经筛选获得有效病例3595例。由于住院费用和住院时间为非正态分布,采用Kruskal Wallis检验进行住院费用的影响因素分析,通过单因素分析和多元线性逐步回归的方法确定影响住院费用的主要因素,筛选出分组变量,用SPSS 18.0统计软件决策树模型中卡方自动互动检验法(CHAID)的方法建立DRGs分类组合方案。结果 3595例子宫肌瘤病例的平均住院费用为10 933.49±4028.79元,年龄分布以40岁~49岁为主占61.91%,婚姻状况以已婚为主占96.58%;患者费用类型以城镇职工医保为主占65.41%;入院途径以门诊入院为主占99.05%;临床路径以完成为主占58.60%,转归情况以治愈为主占77.42%,入出院诊断符合情况以符合为主占99.45%;治疗方式以手术治疗为主占96.55%;合并症/并发症情况以有合并症/并发症为主占61.56%.住院天数、治疗方式、合并症及并发症、年龄、付费方式、转归、临床路径、麻醉方式8个因素对子宫肌瘤住院费用的影响具有统计学差异(P<0.01),其中主要影响因素确定为治疗方式、有无合并症和并发症、住院天数及年龄。3595例子宫肌瘤病例共形成9个DRG组合方案及相应的住院费用参考标准。结论子宫肌瘤患者住院费用组合方案合理,可为医院及政府相关部门制定子宫肌瘤住院费用标准提供参考。Objective To explore the case mixed method in diagnosis-related groups(DRGs)of patients with uterine myoma in Shaoxing and to provide references for standard hospitalization expense of uterine myoma.Methods A total number of 3623 cases with hospital uterine myoma from 3 hospitals in Shaoxing from 2014 to 2016 was collected retrospectively.3595 valid cases were obtained after the filter.Due to the non-normal distribution of hospitalization expenses and hospitalization days,Kruskal Wallis test was used to analyze the influencing factors of hospitalization expenses,and single factor analysis and multiple linear stepwise regression were used to determine the main influencing factors of the hospitalization expenses,DRGs case mix scheme was established by Chi-squared automatic interaction detector in the decision tree model with the statistical software SPSS 18.0.Results The average hospitalization expense of 3595 cases uterine myoma was 10933.49±4028.79 yuan.The age distribution was mainly 40-49 years old,accounting for 61.91%,and the marital status was mainly married,accounting for 96.58%.The medical insurance for urban employees was the main payment method,accounting for 65.41%.The main route of admission was outpatient,accounting for 99.05%.The clinical pathway was mainly completed,accounting for 58.60%.The outcome was mainly cured,accounting for 77.42%,and the coincidence rate of admission and discharge diagnosis was 99.45%.Surgical treatment accounted for 96.55%.The incidence of complications was 61.56%.The length of hospital stay,therapeutic methods,complications,age,payment method,outcome,clinical pathway and anesthesia are all the influencing factors of the hospitalization expense of uterine myoma and there were all statistically significant(P<0.01),and the main influencing factors were therapeutic methods,complications,length of hospital stay and age.The cases of 3595 formed 9 DRGs combinations,with the corresponding hospitalization expense standards of uterine myoma.Conclusion The DRGs case mix schemes of t

关 键 词：子宫肌瘤 住院费用 疾病诊断相关分组 决策树 

分 类 号：R197.323[医药卫生—卫生事业管理] R737.33[医药卫生—公共卫生与预防医学]