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.pdf
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1、:1084论著中国防痨杂志 2 0 2 3 年 11月第 45 卷第 11期Chin JAntituberc,November 2023,Vol.45,No.11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闫晓婧!聂文娟刘海燕安军4池雨晴”初乃惠【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(diagnosisrelatedgroups,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2 0 18 年1月1日至2 0 2 0 年12 月31日确诊患者18 12 例。依据肺结核分类完成基本组
2、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10 9 例,耐药肺结核有17 0 3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-WallisH检验、Mann-WhitneyU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,P0.05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-WallisH检验对分组结果进行检验。结
3、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2 0 58 6.6 6(136 56.41,90 16 3.58)元,年龄3140 岁的是2 32 56.47(17 490.2 6,8 2 919.32)元,年龄4150 岁的是2 1154.19(136 15.14,7 6 2 40.2 8)元,年龄516 0 岁的是2 3544.59(16 32 5.46,8 7 6 0 8.46)元,年龄6 17 0 岁的是2 519 0.2 7(2 0 52 8.0 1,7 8 32 1.0 2)元,年龄7 1岁的是2 48 90.2 4(18 42 4.8 6,91
4、6 6 2.8 9)元;药物敏感的患者住院费用中位数(四分位数)是2 16 93.8 2(16 56 7.2 6,91662.89)元,耐多药患者是2 18 6 6.32(1439 0.17,8 7 8 9 6.56)元,单耐药患者是2 37 0 3.7 0(18 0 2 1.55,9 0 16 3.58)元,广泛耐药患者是18 8 46.98(1140 0.11,7 8 32 1.0 2)元,多耐药患者是2 390 0.6 7(16 0 0 6.0 8,58 8 34.0 3)元;无并发症的患者住院费用中位数(四分位数)是9 7 30.37(536 1.33,2 8 0 53.18)元,并发
5、症数量为15个的患者是20378.65(14110.7 2,9 0 16 3.6 0)元,并发症数量为6 10 个的是2 40 7 2.8 1(17 9 6 6.19,8 7 6 0 8.46)元,并发症数量为1115个的患者是2 4953.2 6(18 411.59,8 7 8 96.56)元,并发症数量为16 2 0 个的是32 530.7 0(2 390 4.41,74195.40)元,并发症数量2 1个的患者住院费用中位数(四分位数)是2 96 47.0 2(2 57 0 7.11,916 6 2.8 9)元;初治患者的住院费用中位数(四分位数)是2 3594.2 4(17 8 90.
6、7 4,916 6 2.8 9)元,复治患者是2 16 6 2.6 3(1436 9.58,87896.56)元。Kruskal-WallisH检验显示,按照年龄、耐药类型和不同并发症分组后住院费用组间差异具有统计学意义(H值分别为58.510、19.556、92.42 4,P值均 0.0 5);Mann-WhitneyU检验显示,按照初治/复治分组后住院费用组间差异具有统计学意义(U=一4.42 2,P0.05)。是否有并发症、初治复治类型、住院时间、年龄均进入了回归模型。在细分组层面,肺结核DRG组划分了5组:药物敏感肺结核;耐药肺结核、住院时间 7 d;耐药肺结核、住院时间8 14d;耐
7、药肺结核、住院时间152 0 d;耐药肺结核、住院时间2 1d。药物敏感肺结核组住院费用中位数(四分位数)是2 16 93.8 2(16 56 7.2 6,916 6 2.8 9)元,耐药肺结核、住院时间 7 d组住院费用中位数(四分位数)是12 334.8 8(7 141.91,597 41.8 3)元,耐药肺结核、住院时间8 14d住院费用中位数(四分位数)是2 0 8 42.2 8(16 459.2 7,8 0 49 6.43)元;耐药肺结核、住院时间152 0 d住院费用中位数(四分位数)是2 6 6 12.13(2 16 8 3.16,90163.58)元;耐药肺结核、住院时间2 1
8、d住院费用中位数(四分位数)是3332 6.8 7(2 56 8 0.93,8 7 8 96.56)元。Kruskal-WallisH检验结果显示H值为6 6 0.2 41,P0.05,各组间差异有统计学意义。各组CV值均 1,符合DRG分组标准;从依据敏感耐药类型划分的基本组到细分组层面,RIV值从0.0 1%上升至33.8 2%,差异性显著提升。结论:在分组要素中引人耐药类型、治疗类型的要素,利于将临床相似性和资源消耗的相似性紧密结合,提高开放科学(资源服务)标识码(OSID)的开放科学计划以二维码为入口,提供丰富的线上扩展功能,包括作者对论文背景的语音介绍、该研究的附加说明、与读者的交互
9、问答、拓展学术圈等。读者“扫一扫”此二维码即可获得上述增值服务。doi:10.19982/j.issn.1000-6621.20230127作者单位:1首都医科大学附属北京胸科医院医务处质控办,北京10 1149;?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,北京10 1149通信作者:初乃惠,Email:注:聂文娟与闫晓婧对本研究具有同等贡献,为并列第一作者中国防痨杂志2 0 2 3年11月第45卷第11期Chin JAntituberc,November 2023,Vol.45
10、,No.11分组的准确性和科学性,建议按照不同肺结核类型分组并在此基础上确定支付标准,提高DRG分组与支付的科学性。【关键词】丝结核,肺;诊断相关患者组;决策树【中图分类号】R197Research on the factors influencing tuberculosis hospitalization costs and diagnosis related grouping Yan Xiaojing,Nie Wenjuan?,Liu Haiyan,An Jun,Chi Yuqing,Chu Naihui?.Quality Control Office,Medical Service,B
11、eijing Chest Hospital,Capital Medical University,Beijing 101149,China;2Department I of Tuberculosis,BeijingChest Hospital,Capital Medical University,Beijing 101149,China;Medicare Office,Beijing Chest Hospital,CapitalMedical University,Beijing 101149,China;*Medical Records Department,Beijing Chest Ho
12、spital,Capital MedicalUniversity,Beijing 101149,ChinaCorresponding author:Chu Naihui,Email:Abstract)Objective:Based on the research on the influencing factors of hospitalization costs,explore thescheme of diagnosis related groups(DRG)of tuberculosis under the classification of tuberculosis,determine
13、 thegrouping according to the cost,and provide a basis for reasonable grouping of DRG.Methods:We collected 1812confirmed patients from Beijing Chest Hospital affiliated to Capital Medical University from January 1,2018 toDecember 31,2020.According to the classification of pulmonary tuberculosis,the
14、basic group level was divided intotwo groups:sensitive pulmonary tuberculosis and drug-resistant pulmonary tuberculosis.There were 109 cases inthe sensitive pulmonary tuberculosis group and 1703 cases in the drug-resistant pulmonary tuberculosis group.Statistical description of the median and quarti
15、le of hospitalization expenses for patients under different factors wasdone.Kruskal Wallis H-test,Mann Whitney U-test,and multiple linear regression methods were used to analyzethe factors affecting hospitalization expenses.P0.05 indicates a statistically significant difference.Using decisiontrees t
16、o process data to complete the division of sub-groups.The coefficient of variation(CV)and reduction invariance(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 h
17、ospitalization expensesof patient groups under different factors.It was found that the median(quartile)hospitalization expenses forpatients aged 30 years old were 20 586.66(13 656.41,90 163.58)yuan,23 256.47(17 490.26,82 919.32)yuanfor those aged 3140 years old,21 154.19(13 615.14,76 240.28)yuan for
18、 those aged 41-50 years old,23 544.59(16 325.46,87 608.46)yuan for those aged 51-60 years old,25 190.27(20 528.01,78 321.02)yuan for thoseaged 61-70 years old,and 24 890.24(18 424.86,91 662.89)yuan for those aged 71 years old.The median(quartile)hospitalization cost for drug sensitive patients was 2
19、1 693.82(16 567.26,91 662.89)yuan,21 866.32(14 390.17,87 896.56)yuan for multidrug-resistant patients,23 703.70(18 021.55,90 163.58)yuan formonodrug-resistant patients,18 846.98(11 400.11,78 321.02)yuan for extensively resistant patients,and23 900.67(16 006.08,58 834.03)yuan for multidrug-resistant
20、patients.The median(quartile)hospitalization costfor patients with 0 complications was 9730.37(5361.33,28 053.18)yuan,20 378.65(14 110.72,90 163.60)yuanfor patients with 1-5 complications,24 072.81(17 966.19,87 608.46)yuan for patients with 6-10 complications,24 953.26(18411.59,87 896.56)yuan for pa
21、tients with 11-15 complications,32530.70(23 904.41,74 195.40)yuan for patients with 16-20 complications,and 29 647.02(25 707.11,91 662.89)yuan for patients with 21complications.The median(quartile)hospitalization cost for newly treated patients was 23 594.24(17 890.74,91 662.89)yuan,while for re-tre
22、ated patients it was 21 662.63(14 369.58,87 896.56)yuan.Kruskal WallisH-test showed that there was statistical significance in hospitalization expenses between groups after groupingaccording to age,drug-resistance type,and different complications(H-values were 58.510,19.556,and 92.424,respectively,P
23、0.05).The Mann Whitney U-test showed that there was a statistically significant difference inhospitalization expenses between groups after initial/recurrent treatment(U=-4.422,P0.05).The presence ofcomplications,type of initial and recurrent treatment,length of hospital stay,and age were all include
24、d in theregression model.At the sub-group level,the DRG group of pulmonary tuberculosis was divided into 5 groups:drug sensitive pulmonary tuberculosis,drug-resistant pulmonary tuberculosis with hospitalization time 7 days,drug-resistant pulmonary tuberculosis with hospitalization time 8-14 days,dru
25、g-resistant pulmonary tuberculosiswith hospitalization time 15-20 days,and drug-resistant pulmonary tuberculosis with hospitalization time 21days.The median(quartile)hospitalization cost for drug sensitive pulmonary tuberculosis group was 21 693.82(16 567.26,91 662.89)yuan.While for drug-resistant p
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