人工全膝关节置换术的住院费用影响因素及病例组合分析  

Analysis of Influencing Factors of Hospital Charges and Case Combination of Total Knee Arthroplasty

作　　者：王秀彬 宋京 史贺 刘炳麟[1] 邬贻萍[1] Wang Xiu bin;Song Jing;Shi He;Liu Binglin;Wu Yiping(Qingdao Municipal Hospital,Qingdao 266071,Shandong Province,China)

机构地区：[1]青岛市市立医院,山东省青岛市266071

出　　处：《中国病案》2021年第6期53-57,共5页Chinese Medical Record

摘　　要：目的分析人工全膝关节置换术住院费用影响因素,探讨DRG病例组合方案,为医院管理人员费用管控和相关部门政策制定提供依据.方法选取某三级综合医院2017年1月1日-2019年12月31日实施人工全膝关节置换手术的出院病例,共获得871例有效病例.使用多元线性回归确定住院费用影响因素并纳入决策树分析,使用卡方自助互动检验法建立决策树模型,获得DRG病例组合方案和费用标准.结果有无其他手术、住院天数、耗材费用占比是住院费用的重要影响因素,P<0.05,可以解释64.3%的费用变异,将这3个变量作为分类节点纳入决策树模型后共建立了8个DRG组合和收费标准,不同DRG组的住院费用比较,差异有统计学意义,P<0.05,超额病例48例,占总病例数的5.51%.结论实施双侧同期膝关节置换手术、缩短术后住院时间、控制耗材费用有利于降低人工全膝关节置换术住院费用.基于CHAID算法建立的人工全膝关节置换术病例住院费用分组模型较为合理,有利于控制住院费用,为DRG付费的推进及相关政策制定提供参考.Objective To analyze the factors affecting the cost of total knee arthroplasty(TKA)and explore the DRGs case combination scheme,so as to provide a basis for the cost control of hospital managers and policy formulation of relevant departments.Methods Select the discharge cases of a third-level general hospital from January 1,2017 to December 31,2019 who performed total knee arthroplasty,using multiple linear regression to determine the factors affecting hospital charges and incorporated into the decision tree analysis,using the chi-square self-service interactive inspection method(CHAID)to build a decision tree model,get the DRG case mix scheme and charge standard.Results The presence or absence of other operations,the length of stay,and the proportion of consumable material expenses were the important factors influencing the hospital charges(P<0.05),can explain 64.3%of the cost variation.After being incorporated into the decision tree model as classification nodes,a total of 8 DRG combinations and charging standards were established.There were statistically significant differences in hospital expenses among different DRG groups(P<0.05),with an excess of 48 cases,accounting for 5.51%of the total number of cases.Conclusion The implementation of bilateral simultaneous knee replacement,shortening the postoperative hospital stay and controlling the cost of consumables is conducive to reducing the hospitalization cost of artificial total knee replacement.The CHAID-based cluster model for the inpatient cost of total knee arthroplasty is reasonable,which is beneficial to control the inpatient cost,which is beneficial to control the inpatient cost,and provide reference for the promotion of DRG payment and relevant policy formulation.and provide reference for the promotion of DRG payment and relevant policy formulation.

关 键 词：膝关节置换术 住院费用 DRG 决策树模型 

分 类 号：R197.3[医药卫生—卫生事业管理]