Liu Lei, Guo Jing, Ding Kun, Zhou Guang-Nao, Feng Yin-Ping, Zhang Na-Na
Department of Quality Management, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China.
Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China.
Technol Health Care. 2024;32(5):3139-3152. doi: 10.3233/THC-231827.
Globally, pulmonary tuberculosis is a significant public health and social problem.
We investigated the factors influencing the hospitalization cost of patients with pulmonary tuberculosis and grouped cases based on a decision tree model to provide a reference for enhancing the management of diagnosis-related groups (DRGs) of this disease.
The data on the first page of the medical records of patients with the primary diagnosis of pulmonary tuberculosis were extracted from the designated tuberculosis hospital. The influencing factors of hospitalization cost were determined using the Wilcoxon rank sum test and multiple linear stepwise regression analysis, and the included cases were grouped using the chi-squared automated interaction test decision tree model, with these influential factors used as classification nodes. In addition, the included cases were grouped according to the ZJ-DRG grouping scheme piloted in Zhejiang Province, and the differences between the two grouping methods were compared.
The length of hospital stay, respiratory failure, sex, and age were the determining factors of the hospitalization cost of patients with pulmonary tuberculosis, and these factors were incorporated into the decision tree model to form eight case combinations. The reduction in variance (RIV) using this grouping method was 60.60%, the heterogeneity between groups was high, the coefficients of variance ranged from 0.29 to 0.47, and the intra-group difference was small. The patients were also divided into four groups based on the ZJ-DRG grouping scheme piloted in Zhejiang Province. The RIV using this grouping method was 55.24, the differences between groups were acceptable, the coefficients of variance were 1.00, 0.61, 0.77, and 0.87, respectively, and the intra-group difference was significant.
When the pulmonary tuberculosis cases were grouped according to the duration of hospital stay, respiratory failure, and age, the results were rather reasonable, providing a reference for DRG management and cost control of this disease.
在全球范围内，肺结核是一个重大的公共卫生和社会问题。
我们调查了影响肺结核患者住院费用的因素，并基于决策树模型对病例进行分组，为加强该病诊断相关分组（DRG）管理提供参考。
从指定的结核病医院提取初诊为肺结核患者病历首页的数据。采用Wilcoxon秩和检验和多元线性逐步回归分析确定住院费用的影响因素，并以这些影响因素作为分类节点，使用卡方自动交互检验决策树模型对纳入病例进行分组。此外，根据浙江省试点的ZJ-DRG分组方案对纳入病例进行分组，并比较两种分组方法的差异。
住院时间、呼吸衰竭、性别和年龄是肺结核患者住院费用的决定因素，将这些因素纳入决策树模型形成8种病例组合。采用该分组方法的方差减少率（RIV）为60.60%，组间异质性高，方差系数范围为0.29至0.47，组内差异小。根据浙江省试点的ZJ-DRG分组方案，患者也被分为四组。采用该分组方法的RIV为55.24，组间差异可接受，方差系数分别为1.00、0.61、0.77和0.87，组内差异显著。
按照住院时间、呼吸衰竭和年龄对肺结核病例进行分组，结果较为合理，为该病的DRG管理及费用控制提供了参考。
