摘要
目的:研究考虑患者异质性的中医医院高血压患者病例组合方式,分析不同类型患者住院费用水平及结构变动情况,为合理监管中医医院高血压患者住院费用以及提高医疗效率提供依据。方法:收集某中医三甲医院1150例高血压患者相关数据,通过单因素和多元线性回归分析确定住院费用关键影响因素,采用决策树模型对高血压患者进行分类,运用新灰色关联分析法和结构变动度法对不同类别患者住院费用结构进行分析。结果:患者年龄、是否合并心脑血管疾病、合并症或并发症个数是影响中医医院高血压患者住院费用的主要因素;采用决策树模型对患者分组,形成5类患者组合,从I类到V类患者费用明显增加,变动度为39.33%;关联度分析结果显示诊断类费用、治疗类费用、西药类费用是引起总费用变动的主要项目,中药类费用和中医类费用分别排在第5位和第7位。结构变动贡献率位居前两位的是诊断类费用(41.23%)和西药类费用(34.58%),二者累计贡献率达到75.81%。结论:中医高血压患者的分组效果显著,能够反映不同类型患者的医疗资源消耗情况。影响住院费用结构的因素主要是诊断类和西药类费用,中医类、中药类费用贡献率偏低,可为中医医院DRG分组、采取差异化费用管理、提高医疗资源效率等提供参考依据。
Objective:To study the case combination method of hypertensive patients in a traditional Chinese medicine hospital considering patient heterogeneity,and to analyze the hospitalization cost levels and structural changes of different types of patients,providing a basis for rational supervision of hospitalization costs and improving medical efficiency.Methods:Data from 1150 hypertensive patients in a Grade III Level A traditional Chinese medicine hospital were collected.Key influencing factors of hospitalization costs were determined through univariate and multivariate linear regression analysis.A decision tree model was used to classify hypertensive patients,and the new grey relational analysis method and structural variability method were employed to analyze the cost structure of different patient categories.Results:Patient age,presence of cardiovascular or cerebrovascular diseases,and the number of comorbidities or complications were identified as major factors affecting hospitalization costs.The decision tree model classified patients into five categories,showing significant cost increases from Category I to Category V,with a variability of 39.33%.Relational analysis indicated that diagnostic costs,treatment costs,and Western medicine costs were the main items causing total cost changes,while traditional Chinese medicine(TCM)costs and Chinese herbal medicine costs ranked fifth and seventh,respectively.Diagnostic costs(41.23%)and Western medicine costs(34.58%)had the highest structural variability contributions,with a combined contribution rate of 75.81%.Conclusion:The grouping of TCM hypertensive patients was effective,reflecting the medical resource consumption of different patient types.The main factors influencing the cost structure were diagnostic and Western medicine costs,with TCM and Chinese herbal medicine costs having lower contribution rates.These findings provide a reference for TCM hospital DRG grouping,differential cost management,and improving medical resource efficiency.
作者
梁丽军
吴瑞
张雪
任建柯
王昕
LIANG Lijun;WU Rui;ZHANG Xue;REN Jianke;WANG Xin(School of Management,Tianjin University of Traditional Chinese Medicine,Tianjin,301617,PRC)
出处
《中国医院》
北大核心
2024年第7期53-56,共4页
Chinese Hospitals
基金
国家自然科学青年基金项目(72104180)
大学生创新创业项目(ZX17)。
关键词
中医医院
住院费用
高血压
决策树模型
结构变动度
traditional Chinese medicine hospital
hospitalization costs
hypertension
decision tree model
structural variability
