中医医院血液系统恶性肿瘤的病例组合研究  

Case-mix study on hematological malignancies from traditional Chinese medicine hospital

作　　者：周歌 谢俊明[1] 吴丽[1] 孙华琴[1] 唐杭琴[1] 吴方园 刘美田 任洁[1] ZHOU Ge;XIE Jun-ming;WU Li;SUN Hua-qin;TANG Hang-qin;WU Fang-yuan;LIU Mei-tian;REN Jie(Department of Medical Record Management,Zhejiang Provincial Hospital of Chinese Medicine,Hangzhou,Zhejiang 310000,China;不详)

机构地区：[1]浙江省中医院病案管理科,浙江杭州310000 [2]宁夏医科大学公共卫生与管理学院,宁夏银川750004 [3]长春市妇幼保健计划生育服务中心儿童早期发展中心,吉林长春130062

出　　处：《现代预防医学》2022年第8期1438-1443,共6页Modern Preventive Medicine

基　　金：浙江省医疗保障局委托项目(ZJCT5-2019154);浙江省自然科学基金项目(LQ20G030015)。

摘　　要：目的 探究适用于中医医院收治血液系统恶性肿瘤(hematological malignancies,HMs)患者的病例组合方案,为相关部门优化浙江省疾病诊断相关分组(diagnosis related group of zhejiang, ZJ-DRG)方案提供参考。方法 收集浙江省某三甲中医医院HMs患者的病案和医保反馈数据,采用线性回归分析和结构方程筛选分类节点,利用决策树模型进行HMs病例分组。结果 本研究中HMs病例组合的分类节点包括输血、化疗、并发症/合并症、骨髓移植、中医治疗和病理类型。1 075例HMs患者共形成8个DRGs组,方差减少量(reduction in variance, RIV)为55.17%,变异系数(coefficient of variation, CV)小于80.0%,组间异质性和组内同质性均达可接受标准。按ZJ-DRG,研究对象被分为21个DRGs组,组间异质性(RIV:30.33%)和组内同质性(CV:21.0%~112.0%)均一般。结论 对于中医医院收治HMs患者,现行ZJ-DRG分组方案还有待完善,可考虑增加输血、中医治疗等因素以提高DRG分组效果。Objective To explore the case-mix scheme suitable for in-patients with hematological malignancies(HMs) form Traditional Chinese Medicine(TCM) Hospital, and provide references for relevant medical insurance departments to improve Diagnosis Related Group(DRG) scheme of Zhejiang Province. Methods HMs in-patients in a tertiary TCM hospital of Zhejiang were selected, and their medical record homepage and the feedback data of medical insurance were collected.Linear regression analysis and structural equation modeling were used to screen categorical node variables, and decision tree model was used to group HMs in-patients. Results The categorical variables of HMs in-patients in this study included blood transfusion, chemotherapy, complications, bone marrow transplantation, Chinese medicine treatment, and pathological types.In total 1 075 in-patients formed eight DRGs, the reduction in variance(RIV) was 55.17%, and the coefficient of variation(CV) was less than 80.0%. Consequently, between-group heterogeneity and within-group homogeneity reached the acceptable standards. However, HMs in-patients were divided into 21 DRGs according to the ZJ-DRG scheme, and the heterogeneity between these groups(RIV: 30.33%) and the homogeneity within these groups(CV: 21.0%-112.0%) were average. Conclusion For HMs in-patients in TCM hospital, the existing ZJ-DRG scheme needs to be improved, and factors such as blood transfusion and Chinese medicine treatment can be considered to improve the grouping effects of DRGs.

关 键 词：血液系统恶性肿瘤 中医医院 病例组合 结构方程 决策树 

分 类 号：F840.684[经济管理—保险] R197.4[医药卫生—卫生事业管理]