Study On Single Disease Of DRGs Based On Hospitalization Expenses In Cholecystitis Patients

Objective:To investigate the structure of hospitalization expenses of cholecystitis inpatients, the data of cholecystitis inpatients insured in Tianjin from2003to2007were described, and multinomial linear regression and structural equation model were used to analyze the factors influencing hospitalization expenses. Then, try to establish the case mix model which will be applicable to cholecystitis inpatients in Tianjin by using decision tree analysis. The proportion of expense exceeding the threshold and patients exceeding the threshold in cholecystitis inpatients of Tianjin were computed and find the control points and provide the basis for the development of health cost control policies and the improvement of payment of medical expenses. It will provide reference and scientific basis in implementation the DRGs of single diseases policy in our country.Methods:1568qualified cholecystitis patients were collected from15%cases which were diagnosed with cholecystitis (ICD-10number is K81),which selected randomly from medical insurance database within2003to2007of Tianjin residents. Multinomial linear regression and structural equation model were used to analyze the factors influencing hospitalization expenses with SPSS16.0and AMOS7.0. Establishing the case mix model and analyzing the proportion of expense exceeding the threshold and patients exceeding the threshold in cholecystitis inpatients of Tianjin by using Clementine12.0.Results:1. The cholecystitis patients in men is703, accounting for44.8%; Women865, accounting for55.2%.Age ranges from22to96(M=58, IQR=19)years, the age group younger than45is218, accounting for13.9%;age from45to59-year is619, accounting for39.5%; age group older than60is731, accounting for46.6%.The length of stay is from2days to91days, the mean is12.76±9.1days (M=10, IQR=8). Hospitalization expenses are from471.87yuan to24453.44yuan, the mean is8320.79±4536.7yuan(M=7506.48, IQR=6022.30). Of all the patients, there are1325with complications, accounting for84.5%, none is243, accounting for15.5%.Those patients with surgery is913, accounting for58.2%, no surgery is655, accounting for41.8%.In Level of the hospital is655, accounting for41.8%;second-class hospital is531, accounting for33.9%;tertiary hospitals is863, accounting for55.0%.There are1304, accounting for83.20%in six urban districts;160, accounting for10.2%in suburban county;104, accounting for6.6%in development area.2. The result of multinomial linear regression analysis showed that for cholecystitis patients, the major influential factors as follows:surgery or not(β’=-0.544), length of stay(β’=0.373), hospital’s level (β’=0.295), age(β’=0.097), times of hospitalization (β’=0.043), gender (β’=0.037) and complication (β’=0.034).3. The result of structural equation model showed that age, sex, complication, surgery or not, times of hospitalization, length of stay, hospital’s level, districts to participate in medical insurance, year to participate in medical insurance impact on the hospitalization expenses directly and indirectly. The correlates F3except patients themselves impact on hospitalization expenses directly, the effect is0.39, The correlates F2patients themselves impact on hospitalization expenses directly0.69and also indirectly through length of stay. The effect of F2to F1is0.14, F1to F4is0.54.4. There are8case mix from the CART decision tree. There is only1case mix not exceeding the hospitalization expenses threshold. The hospitalization expenses(RMB) and the number of patients exceeding the threshold are as follows:28379.90,12;43772.85,15;6136.27,5;0,0;11213.73,7;7690.18,4;84759.81,24;20409.12,11.Total exceeding the threshold number of patients is78and hospitalization expenses is202361.89yuan in this study about the hospitalization expenses of cholecystitis inpatients of Tianjin.Conclusion:By using multinomial linear regression and structural equation model analyze the influential factors of cholecystitis patients’hospitalization expenses, we not only find out the meaningful factors, but also find out the specific roles of the factors on the hospitalization cost. Additionally, compared with previous studies, the grouping variables of our case mix model included both variables reflected the clinical characteristics and those reflected the social characteristics of patients. In subsequent study, we need to enhance the quality of records management, the standardization of clinical pathway and so on, in order to make case mix model closer to actual conditions, and make DRGs of single disease payment be the references for reform of health care system of China.