基于DRGs的住院医疗费用分析-企业管理专业论文.docxVIP

摘要摘要 摘要 摘要 病例分组被广泛地认为是一种直接、合理、有效地医疗产出测量单位，疾病 诊断相关组(Diagnosis-related Groups，Dl沁s)是以医疗资源消耗为分组轴心而发展 起来的一种病例分组模型。美国从1983年开始实施的预付制度(Prospective Payment System，PPS)就是以DRGs为基础发展起来的。此后，美国医疗费用的增 长得到了显著遏制。国内有关DRGs的研究尚处于探索阶段。由于各省的实际情 况差别较大，所以有必要研究符合西安实际情况的DRGs。 由于搜集到的数据有限，本次DRGs病例分组研究仅以样本量最大的恶性肿 瘤为例。首先使用统计分析方法中的非参数检验和多元线性回归模型分析住院医 疗费用的影响因素，选择其中的显著影响因素做DRGs病例分组的分类变量，选择 决策树方法中的卡方自动交互检测(chi．squared Automatic／nterracfion Detector， CIiAID)为分类方法建立DRGs病例分组模型，在分组的基础上确定各组病例住院 医疗费用的标准以及超标费用的阀值。最后对超标费用做进一步的分析，利用数 据挖掘技术中的关联规则分析方法，挖掘超标费用和产生超标费用的可能因素之 间的规则。其中，数据分析分别在SPSSl3．0和Clementine8．0中进行。 本研究建立的DRG-s病例分组模型为客观评价医疗产出、为制订医保机构的 偿付标准提供了科学依据，对于规范医疗行为、合理使用医疗资源起到了引导作 用，同时也为制订合理实用的医疗资源消耗标准奠定了基础。 关键词：DRGs住院医疗费用决策树关联规则 Abstractcase-mix Abstract case-mix iS widly considered as a direct,reasonable and efficient measuerment unit of hospital output,DRGs is a case-mix model originally devepoed based on the classification axe ofhospital leSoulco consumption intensity．In American，Prospective Payment System(PPS)that was put into praetico in 1983 is developed based on DRGs．During these decade years,American increased medical expense Was eomroled remarkably．The research Was lately bagun to study in 0111country,which is still at the beginning of explore stage．It is varies greatly fiom one province to another,it is necessary to develop a hospitalization consumption control unit such as DRGs in xi’an． DRGs need lots of cases，SO the research based 0n Malignant tumor because it has plenty ofcases．The key about DRGs is how to select variables and methods．Firstly,the rank sum test and multiple Linear regression analysis,was be used to study the ilffluencing factors of inpatient’S costs．Then we established DRGs model by decision tree,which c趾supply the expense criteria for medicare organise and hospital． Finally，association rules mining is applied to the outlier expense to fme out the association of factors．the data analysis worked on the computer by the data mining soR-spssl3．0 and clementine8．0． The study resul