基于决策树和结构方程模型的HIV/AIDS患者CHS-DRG分组效果检验  

Testing the effect of CHS-DRG in HIV/AIDS patients based on decision tree and structural equation modeling

作　　者：孙梗钤 卿勇[3] 张眆凯 蒲欣 周晓羽 李朝娟 陈丹镝 SUN Geng-qian;QING Yong;ZHANG Fang-kai;PU Xin;ZHOU Xiao-yu;LI Chao-juan;CHEN Dan-di(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu,Sichuan 610041,China;不详)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院,四川成都610041 [2]四川大学华西-协和陈志潜卫生健康研究院,姑息医学中心 [3]成都肛肠专科医院

出　　处：《现代预防医学》2023年第8期1499-1503,共5页Modern Preventive Medicine

基　　金：国家社会科学基金(16BMZ112)。

摘　　要：目的探索艾滋病病毒感染者及病人(People Living with HIV/AIDS,PLWHA)的病例组合方案,与现行CHS-DRG分组过程进行对比,为推进医保支付方式改革提供依据。方法提取成都市2所三甲医院PLWHA病案数据,构建线性回归模型和结构方程模型筛选分类节点变量,采用决策树模型进行病例分组。使用变异系数(CV)和方差减少量(RIV)对CHS-DRG分组结果和本文模拟分组结果进行效果评价。结果PLWHA的分类节点包括是否手术、合并症/并发症数量、是否中医治疗、临床分期,共形成5个病例组;CHS-DRG各病例组住院费用CV均<0.8,组间RIV<0.4,模拟所得DRG组住院费用CV均<0.8,组间RIV>0.4,相较于CHS-DRG分组结果,研究模拟所得DRG组的分组效果较好。结论对于PLWHA患者,现行CHS-DRG分组方案还有待完善,可考虑增加是否中医治疗、临床分期、合并症/并发症数量等因素以提高DRG分组效果。Objective To explore the DRG grouping scheme for people living with HIV and patients(PLWHA)and to compare it with the current CHS-DRG grouping process to provide a basis for advancing health insurance payment reform.Methods The data of PLWHA cases from 2 tertiary hospitals in Chengdu were extracted,linear regression models and structural equation models were constructed to screen classification node variables,and decision tree models were used for grouping.The coefficient of variation(CV)and reduction in variance(RIV)were used to evaluate effectiveness of CHS-DRG grouping results and simulated grouping results in this paper.Results The classification nodes of PLWHA included whether to operate,number of comorbidities/complications,whether to treat with Chinese medicine and clinical stage,forming a total of 5 case groups.The CV of hospitalization cost for each case group of CHS-DRG was<0.8,and the RIV between groups was<0.4.The CV of hospitalization cost for the DRG group obtained from the simulation was<0.8,and the RIV between groups was>0.4.Compared with the results of CHS-DRG grouping,the grouping effect of the DRG group obtained from the study simulation was better.Conclusion For PLWHA patients,the current CHS-DRG grouping scheme still needs to be improved,and factors such as whether to treat with Chinese medicine,clinical stage,and the number of comorbidities/complications can be considered to improve the DRG grouping effect.

关 键 词：决策树 结构方程模型 CHS-DRG HIV 住院费用 

分 类 号：R195[医药卫生—卫生统计学]