Analysis And Diagnosis-related Groups Based On Inpatient Records Of Zhejiang Province

Case-mix is widely considered as a direct, reasonable and efficient measurement unit of hospital output. In Diagnosis-related Groups (DRGs) classification manual which is certificated by American official, case-mix is defined as a classification system of a series of interrelated and different patients' characteristics, including the state of an illness, disease prognosis, the difficulty of treatment, the necessity for treatment and consumption intensity of hospital resource. There are many different case mix models at present, but their difference is only in the emphasis, that is, they are different in classification axes. The diagnosis-related groups (DRGs) classification is a case-mix model originally developed based on the classification axe of hospital resource consumption intensity.Researches on DRGs and application of DRGs have been frequently performed for several decades, and have achieved great progress in developed countries. In America, Prospective Payment System (PPS) that was put into practice in 1983 is developed based on DRGs. American medical expenses increased by two-digit numbers every year before 1990, and decreased to one-digit after 199O.The expense decreased gradually, and reached 4.6% in 1996 which was the lowest of the last 40 years. At present, many developed countries such as Australia, England, France, Sweden etc have performed the research about the DRGs, and all made a lot of progress.With the rapid and persistent development of economy in our country, great improvement in people's income, health expenses have increased rapidly and persistently. According to the results of the measurement of total health expenses, the total health consumption of the whole country in 2002 is about 50 times more than that in 1978, that is, it came to 568.463 billions yuan in 2002 while 11.021 billions yuan in 1978. So it is very important now to develop a hospitalization consumption control unit such as DRGs in our country. In 2000, based on ICD-9 , Xu yongyong etc. established CADRG132 (China Adjusted DRG132) . At present, the research about the DRGs is still at the beginning of the theory-exploration stage, and it varies greatly from one province to another. Many hospitals have made use of ICD-10, so it is difficult to generalizeapplication of CADRG over the whole country. The purpose of this research is to recombine different diseases through case-mix, by analyzing the information offered by inpatient records in Zhejiang Province, to explore the Zhejiang adjusted DRGs, and then evaluate the output of hospital and control the medical expenses of patients better.ObjectiveEstablish the DRGs based on the information of inpatient records in Zhejiang Province and including ordinary diseases; and then according to the DRGs established, analyze the health resources consumption in Zhejiang Province, explore the main risk factors, estimate the output of all kinds of hospitals and analyze the payments of different people; and then make some corresponding suggestions.Data and methodsData came from information of the inpatient records offered by 4 hospitals in Zhejiang Province. Under the guidance of professional experts, we chose 2 provincial hospitals and 2 civic hospitals, which are representative. There are 128601 cases collected in all. After eliminating the imperfect cases, illogical cases and the cases that are not cured, and filtering the cases whose hospitalization expenses were less than P2.5 or more than P97.5, we got 115453 effective cases finally, which were 89.78 % of the total cases.We used Automatic Interaction Detector(AID) to establish tree model and produced case mix scheme; adopted the Chi-squared Automatic Interaction Detector(CHAID) to analyze the risk factors for patients exceeding the threshold; and adopted Kruskal-Wallis test to compare the medical consumptions for people who have different characteristics, and made use of multiple linear regression to analyze the medical consumptions.All statistical analysis is done by SAS8.2.Results(1) Medical resource consumption analysis of inpatientsIn...