痔疮病例诊断相关分组再细分策略研究

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中图分类号：R197.32；R735.3 文献标识码：A

Abstract ObjectiveTo investigate the hospitalization expenses and influencing factors of hemorrhoid patients， explore the strategy for further subgrouping withinthe Diagnosis-Related Group （DRG） system for hemorrhoid cases， and provide references for improving DRG grouping.MethodsThe data from the front pages of medical records of 98 hemorrhoid cases from twotertiary hospitals andone secondary hospitalfrom Ol9 to 0 were selected.Univariateanalysis and multiple linear regresion analysis were used to explore the influencing factors of caseexpenses.Combined with theopinions of clinical experts，a decision tree model was employed to subdivide hemorhoid cases，and the subgrouping results were compared with the DRG grouping results from the National Healthcare Security Administration.ResultsLengthof hospital stay，typeof surgery，numberof surgical procedures performed，classificationof primarydiagnosis，and number of other diagnoses are influencing factors of hospitalization expenses for hemorhoid cases （all P<0.05 ）. Hemorrhoid cases were divided into 9 DRG groups，with a Reduction in Variance （RIV） of O.44，which was higher than the RIV value （O.6） of the DRG grouping by the National Healthcare Security Administration. The coeficient of variation for each group rangedfrom 0.9 toO.4.ConclusionBased on DRG groupig，it is reasonable to further subdivide hemorrhoid cases according to the type of surgery and the number of surgical procedures.This approach can improvethe consistency of expenses within subgroups and the diferences between groups，better fit the medical resource consumption of cases，and provide ideas for improving DRG grouping.

Key words Hemorrhoid;DRG；Subgrouping；Medical Insurance Payment；Decision Tree Model First-author's：address College of Public Health and Health Professions，Hubei University of Medicine，Shiyan， Hubei，44000，China

合理的病例分组能够准确反映 保支付精准性，提升医师对医保支医疗资源消耗情况，有利于提高医 付方式认同感。（剩余4706字）