基于决策树E-CHAID算法的腰椎椎管狭窄症住院患者DRGs分组研究  

Diagnosis Related Groups Grouping of Patients with Lumbar Spinal Stenosis based on Decision Tree E-CHAID Algorithm

作　　者：宗丽婕 潘源 程立维 王辉宇 冯郡琪 廖军[2] 王前强 ZONG Lijie;PAN Yuan;CHENG Liwei;WANG Huiyu;FENG Junqi;LIAO Jun;WANG Qianqiang(School of Humanities and Social Sciences,Guangxi Medical University,Nanning,530021,China;不详)

机构地区：[1]广西医科大学人文社会科学学院,广西南宁530021 [2]广西医科大学第一附属医院脊柱骨病外科,广西南宁530021

出　　处：《中国社会医学杂志》2025年第2期207-210,共4页Chinese Journal of Social Medicine

基　　金：国家社会科学基金项目(18XZZ013);广西哲学社会科学规划研究课题(2018RWA01)。

摘　　要：目的了解腰椎椎管狭窄症住院患者的住院费用成本构成和影响因素,确定合理的成本分组方案。方法在广西壮族自治区某三级甲等综合医院信息系统中抽取出院时间在2018年7月-2023年6月的8458例主要诊断为腰椎椎管狭窄且主要手术为“前柱腰和腰骶部融合术,后路法”患者的相关资料,对比患者住院费用构成情况并对住院费用的影响因素进行多因素分析,利用E-CHAID算法构建DRGs分组方案,利用变异系数及Kruskal-Wallis H检验评价成本分组的合理性,制定各DRG分组参考费用。结果根据住院天数、是否有合并症和并发症、年龄三个分类节点将8458例患者分为6个DRG分组。Kruskal-Wallis H检验结果显示,各DRG分组的组间差异具有统计学意义(H=990.749,P<0.001),变异系数为0.25~0.32。结论基于决策树模型E-CHAID算法建立的腰椎椎管狭窄DRGs分组合理,可为医疗机构合理控费、提高医疗质量与效率提供依据,同时为该地区开展DRGs医保付费提供参考。Objective To investigate the cost composition and influencing factors of inpatients with lumbar spinal stenosis,and to determine a reasonable cost grouping scheme.Methods The data of 8458 patients with lumbar spinal stenosis who were discharged from July 2018 to June 2023 and whose main operations were"anterior column and lumbsacral fusion,posterior approach"were extracted from the information system of a grade-A tertiary general hospital in Guangxi Zhuang Autonomous Region.The composition of inpatient expenses was compared and the influencing factors of inpatient expenses were analyzed with multiple factors.The diagnosis related groups(DRG)grouping scheme was constructed by using E-CHAID algorithm,the rationality of cost grouping was evaluated by using coefficient of variation and Kruskal-Wallis H test,and the reference costs of each DRG grouping were formulated.Results The 8458 patients were divided into 6 DRG groups by three classification nodes:length of stay,comorbidities and complications,and age.Kruskal-Wallis H test showed that the difference between the DRG groups was statistically significant(H=990.749,P<0.001),and the coefficient of variation CV was 0.25-0.32.Conclusion The cases of lumbar spinal stenosis established based on the decision tree model E-CHAID algorithm were grouped reasonably.The grouping scheme and hospitalization cost standard could provide a basis for reasonable cost control in medical institutions,improve medical quality and efficiency,and provide a reference for carrying out DRGs medical insurance payment in this region.

关 键 词：腰椎椎管狭窄 决策树模型 住院费用 疾病诊断相关分组 穷举卡方自动交互检测方法 

分 类 号：R197.32[医药卫生—卫生事业管理]