肺结核患者住院费用影响因素与按疾病诊断相关分组方案研究  

Research on the factors influencing tuberculosis hospitalization costs and diagnosis related grouping

作　　者：闫晓婧 聂文娟[2] 刘海燕[3] 安军[4] 池雨晴 初乃惠[2] Yan Xiaojing;Nie Wenjuan;Liu Haiyan;An Jun;Chi Yuqing;Chu Naihui(Quality Control Office,Medical Service,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;DepartmentⅠof Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;Medicare Office,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;Medical Records Department,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院医务处质控办,北京101149 [2]首都医科大学附属北京胸科医院结核一科,北京101149 [3]首都医科大学附属北京胸科医院医疗保险办公室,北京101149 [4]首都医科大学附属北京胸科医院病案科,北京101149

出　　处：《中国防痨杂志》2023年第11期1084-1089,共6页Chinese Journal of Antituberculosis

摘　　要：目的:基于住院费用影响因素的研究,探索在结核病分类下肺结核的按疾病诊断相关分组(diagnosis related groups,DRG)方案,依据费用情况确定分组,为合理划分DRG分组提供依据。方法:收集首都医科大学附属北京胸科医院2018年1月1日至2020年12月31日确诊患者1812例。依据肺结核分类完成基本组层面的划分,肺结核DRG基本组划分为敏感肺结核和耐药肺结核2组,敏感肺结核组有109例,耐药肺结核有1703例。对不同要素下患者住院费用的中位数(四分位数)进行统计描述;采用Kruskal-Wallis H检验、Mann-Whitney U检验和多重线性回归方法对影响住院费用的因素进行分析,P<0.05为差异有统计学意义;采用决策树处理数据完成细分组的划分;采用变异系数(coefficient of variation,CV)和方差减少量(reduction in variance,RIV)对分组的组内同质性和组间异质性进行评价,采用Kruskal-Wallis H检验对分组结果进行检验。结果:分析不同要素下患者群体住院费用发现,年龄≤30岁的住院费用中位数(四分位数)为20586.66(13656.41,90163.58)元,年龄31~40岁的是23256.47(17490.26,82919.32)元,年龄41~50岁的是21154.19(13615.14,76240.28)元,年龄51~60岁的是23544.59(16325.46,87608.46)元,年龄61~70岁的是25190.27(20528.01,78321.02)元,年龄≥71岁的是24890.24(18424.86,91662.89)元;药物敏感的患者住院费用中位数(四分位数)是21693.82(16567.26,91662.89)元,耐多药患者是21866.32(14390.17,87896.56)元,单耐药患者是23703.70(18021.55,90163.58)元,广泛耐药患者是18846.98(11400.11,78321.02)元,多耐药患者是23900.67(16006.08,58834.03)元;无并发症的患者住院费用中位数(四分位数)是9730.37(5361.33,28053.18)元,并发症数量为1~5个的患者是20378.65(14110.72,90163.60)元,并发症数量为6~10个的是24072.81(17966.19,87608.46)元,并发症数量为11~15个的患者是24953.26(18411.59,87896.56)元,并发症数量为16~20个的是32530.70(23904.41,74195.40)元,并发Objective:Based on the research on the influencing factors of hospitalization costs,explore the scheme of diagnosis related groups(DRG)of tuberculosis under the classification of tuberculosis,determine the grouping according to the cost,and provide a basis for reasonable grouping of DRG.Methods:We collected 1812 confirmed patients from Beijing Chest Hospital affiliated to Capital Medical University from January 1,2018 to December 31,2020.According to the classification of pulmonary tuberculosis,the basic group level was divided into two groups:sensitive pulmonary tuberculosis and drug-resistant pulmonary tuberculosis.There were 109 cases in the sensitive pulmonary tuberculosis group and 1703 cases in the drug-resistant pulmonary tuberculosis group.Statistical description of the median and quartile of hospitalization expenses for patients under different factors was done.Kruskal Wallis H-test,Mann Whitney U-test,and multiple linear regression methods were used to analyze the factors affecting hospitalization expenses.P<0.05 indicates a statistically significant difference.Using decision trees to process data to complete the division of sub-groups.The coefficient of variation(CV)and reduction in variance(RIV)were used to evaluate intra group homogeneity and inter group heterogeneity between the groups,and the Kruskal Wallis H test was used to test the group results.Results:We analyzed the hospitalization expenses of patient groups under different factors.It was found that the median(quartile)hospitalization expenses for patients aged≤30 years old were 20586.66(13656.41,90163.58)yuan,23256.47(17490.26,82919.32)yuan for those aged 31-40 years old,21154.19(13615.14,76240.28)yuan for those aged 41-50 years old,23544.59(16325.46,87608.46)yuan for those aged 51-60 years old,25190.27(20528.01,78321.02)yuan for those aged 61-70 years old,and 24890.24(18424.86,91662.89)yuan for those aged≥71 years old.The median(quartile)hospitalization cost for drug sensitive patients was 21693.82(16567.26,91662.89)yuan,21866.32(14390.

关 键 词：结核 肺 诊断相关患者组 决策树 

分 类 号：R197[医药卫生—卫生事业管理]