基于DRG/DIP的急性心肌梗死患者病例组合及住院费用分析  

Case-mix of patients with acute myocardial infarction and analysis of inpatient hospital costs based on DRG/DIP

作　　者：靳秀平 JIN Xiuping(Changzhi People s Hospital,Changzhi Shanxi 046000,China)

机构地区：[1]长治市人民医院,山西长治046000

出　　处：《卫生软科学》2025年第3期69-74,共6页Soft Science of Health

摘　　要：[目的]通过研究某三甲医院急性心肌梗死(Acute Myocardial Infarction,AMI)患者病例组合及住院费用构成,为优化该病种分组方案及付费标准提供依据。[方法]收集某三甲医院2019年1月至2023年12月AMI患者4288例,采用单因素分析和多元线性回归分析住院费用的影响因素,筛选出分类节点变量,利用决策树建立患者疾病诊断相关组法(Diagnosis Retated Groups,DRG)病例组合模型并制定费用标准,通过变异系数、方差减少量和Kruskal-Wallis H检验对病例组合模型进行效果评价。[结果]住院天数、年龄、入院途径、手术/操作个数、其他诊断个数和抢救次数是影响住院费用的主要因素。将上述因素纳入决策树模型,共形成11个病例组合和收费标准,能解释83.72%的实际费用,超线患者占比6.90%,消耗了8.47%的医疗资源。[结论]通过决策树模型建立的AMI患者DRG分组合理,并获得相应住院费用标准及病种权重。对病例分组进行超线费用分析,明确了线内外的费用构成,为该地区医保部门制定决策、控制医疗费用不合理增长提供参考。Objective This study provides the basis for optimizing the disease grouping scheme and payment standards of acute myocardial infarction(AMI)by studying the case-mix and the composition of inpatient hospital costs of patients with AMI at a tertiary hospital.Methods Univariate analysis and multiple linear regression were used to analyze the influencing factors of hospitalization costs of 4288 patients with AMI from a tertiary hospital from January 2019 to December 2023.Variables of classification thresholds were screened out.A case-mix model for Diagnosis Related Groups(DRG)was developed and the cost standards were established by using the decision tree.The effectiveness of the case-mix model was evaluated by coefficient of variation,variance reduction,and Kruskal-Wallis H-Test.Results Length of hospital stay,age,types of hospital admissions,number of surgeries/procedures,number of other diagnoses and number of emergencies were the main factors influencing inpatient costs.The above factors were incorporated into the decision tree model,forming 11 case-mix groups and charging standards,which could explain 83.72%of the actual costs.The patients who exceeded the cost limitations accounted for 6.90%,consuming 8.47%of medical resources.Conclusions DRG of patients with AMI established by decision tree model were reasonable in this study,and the corresponding hospitalization cost standards and disease weights were obtained.Analysis of exceeded costs was carried out for the disease groups to clarify cost components for both within and outside the cost thresholds,which provides a reference for the decision-making of the local healthcare security department and controls the unreasonable growth of medical expenses.

关 键 词：DRG/DIP 急性心肌梗死 决策树 住院费用 

分 类 号：R197.1[医药卫生—卫生事业管理]