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目的通过合理分组,制定精神分裂症患者住院费用发生额度的参考范围,为实现医保基金的合理使用与监管提供决策依据。方法以疾病诊断相关分组(diagnosis related groups,DRGs)核心思想为指导,采用决策树分析的卡方自动交互检测法(Chi-square automatic interaction detection,CHAID)算法,对患者进行细化分组并制定医疗费用合理范围。结果 (1)最终医院级别、住院天数、曾住院次数被用作截断点变量,生成一棵总节点数为21,终节点数为13,树深为3的决策树统计模型。(2)全部病例共形成13个病例组合,共筛选出1 096例可疑案例,构成比为10.03%,发生费用占总发生费用的21.60%(7 165 046.09/33 171 509.68);超额费用占发生费用的24.74%(1 772 930.71/7 166 251.86),占总发生费用的5.34%(1 772 930.71/33 171 509.68)。结论将DRGs方案应用于本病种,通过将患者合理分组来研究住院费用问题可为医疗保险基金的合理使用和监管提供一条可循的管理路径。
Objective To establish the reference range of the occurrence of schizophrenia inpatient expenses through reasonable grouping so as to provide decision-making basis for the rational use and supervision of medical insurance fund. Methods Chi-square automatic interaction detection (CHAID) algorithm was used to guide the diagnosis of groups of patients (DRGs), and the patients were divided into groups and developed medical treatment Reasonable range of costs. Results (1) The final hospital grade, hospitalization days and the number of hospitalizations were used as truncation point variables to generate a statistical tree model with 21 total nodes, 13 final nodes and 3 tree depths. (2) A total of 13 cases were found in all the cases. A total of 1 096 suspicious cases were screened out, with a constituent ratio of 10.03%, accounting for 21.60% (7 165 046.09 / 33 171 509.68) of the total costs incurred; the excess expenses accounted for 24.74% (1 772 930.71 / 7 166 251.86) of the costs, accounting for 5.34% (1 772 930.71 / 33 171 509.68) of the total costs incurred. Conclusion Applying DRGs to this disease and studying the cost of hospitalization by reasonably grouping patients can provide a manageable way for the rational use and supervision of medical insurance fund.