北京市某三级甲等医院基于费用结构的病种聚类分析  

Cluster analysis of diseases based on cost structure in a tertiary hospital in Beijing

作　　者：陈美玲 李磊 王佳静 马静 王中菲 万钢 Chen Meiling;Li Lei;Wang Jiajing;Ma Jing;Wang Zhongfei;Wan Gang(Department of Medical Records Statistics,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院病案统计科,北京100015

出　　处：《中国医院统计》2024年第6期457-460,共4页Chinese Journal of Hospital Statistics

摘　　要：目的依据费用结构对住院患者的病种进行分类,为控制医疗成本和优化医疗收入结构提供数据参考。方法选取北京市某三级甲等医院2023年1月至2024年6月住院患者病案首页信息,提取住院费用明细,以出院主要诊断的ICD-10疾病诊断编码为病种划分依据,使用K-means聚类分析将各病种按照费用结构进行分类,分析各类别病种的费用结构特点。结果基于费用结构将患者病种分为4类,1类病种是耗占比较高的疾病分类,主要包括肾积脓、输尿管结石和不稳定性心绞痛等病种;2类病种诊断类费用占比最高,主要包括其他和未特指的肝硬交,酒精性肝硬交、慢性乙型病毒性肝炎(不伴有δ因子)等病种;3类病种各项费用占比较均衡,主要包括泌尿装置的安装和调整、未特指的肝恶性肿瘤、医疗性流产(无并发症)等病种;4类病种药占比相对较高,主要包括其他特指的医疗照顾、慢性肝衰竭、肿瘤化学治疗疗程等病种。结论耗占比或药占比高虽有病种本身治疗要求的原因,仍需从采购、使用和管理等多个环节入手降低费用,以实现医疗费用的有效控制和医疗服务质量的提升。Objective To classify hospitalized patients'diseases based on cost structure,and to provide data reference for controlling medical costs and optimizing the structure of medical income.Methods The first page information of inpatient cases from January 2023 to June 2024 in a tertiary hospital in Beijing was selected to extract inpatient expense details,and patients were categorized based on the ICD-10 disease diagnosis codes of their primary discharge diagnoses.K-means clustering analysis was used to classify diseases according to cost structure,so as to analyze the characteristics of each category's cost structure.Results Based on cost structure,patient diseases were classified into four categories.Category 1 included diseases with high consumable costs,mainly comprising pyonephrosis,ureteral stones,and unstable angina pectoris;category 2 had the highest diagnostic fees,including unspecified liver cirrhosis,alcoholic liver cirrhosis,chronic hepatitis B without delta agent,etc.;category 3 featured balanced proportions across all fee types,including installation and adjustment of urinary devices,unspecified liver malignancies,medical abortion without complications,etc.;category 4 had relatively higher medication costs,including other specified medical care,chronic liver failure,and chemotherapy sessions for tumors,among others.Conclusion Although high consumable or medication costs may be due to treatment requirements of certain diseases,it is still necessary to reduce expenses through multiple links such as procurement,usage,and management to effectively control medical costs and improve the quality of medical services.

关 键 词：病种分类 费用结构 K-means聚类分析 耗占比 

分 类 号：R47[医药卫生—护理学]