| Objectives: To understand the internal constitution and external influence factors of hospitalization expenses for patients with stroke,this article analyzes the cost of hospitalization for stroke patients in different subtypes in Lanzhou City from 2014 to 2016.Based on the above analysis,the decision tree algorithm in data mining is used to explore the grouping of cases with hemorrhagic stroke and ischemic stroke provided a certain reference for the disease diagnosis in some relevant subgroups in Lanzhou.In order to control the excessive growth of medical expenses,reasonable solutions are also provided to solve the problem like difficulty of expensive medical treatment.Methods: From the dedicated data statistics platform of Gansu Provincial Health and Family Planning Commission,the Health and Family Planning Statistical Information Network Direct Reporting System obtained relevant information from the home medical records of discharged patients in all hospitals of grade 3 or above hospitals in Lanzhou from January 1,2014 to December 31,2016.According to the revised version of the International Classification of Diseases(ICD-10)in our country in 1995,9557 cases of hospitalized patients with primary diagnosis of stroke(the first three in the ICD-10 code for I60-I64)were selected.The classification criteria for cerebrovascular disease were established.The stroke data were divided into two categories: hemorrhagic stroke(subarachnoid hemorrhage,intracerebral hemorrhage and other non-traumatic intracranial hemorrhage)and ischemic stroke(cerebral infarction).The basic situation of patients with hemorrhagic and ischemic stroke was described;the internal composition of hospitalization costs for patients with hemorrhagic and ischemic stroke was analyzed based on the new grey correlation analysis and structural variability analysis;Multiple linear regression methods were used.Analysis of external factors in hospitalization costs for patients with hemorrhagic and ischemic strokes and hemorrhage and ischemic stroke patients hospitalized fees established a case mix model by using the CART analysis in Clementine 12.0 software.Results: i.)Basic situation of patients with stroke: There were 1256 male patients with hemorrhagic stroke and 744 female patients between 2014 and 2016.The average age of hospitalized patients was(59.62±16.25)years,and the average age of male patients was(58.52±16.12)years.The average age of female patients was(61.49±16.32)years old,and patients aged 45 and above accounted for 82.55% of the total number of samples.Patients were mostly concentrated in the elderly.Between 2014 and 2016,hospitalization expenses for patients with hemorrhagic strokes showed an upward trend,and the total cost of hospitalization was(25210.21±27729.47)yuan.Among different genders,the average hospitalization cost for male patients was 25,385.75 yuan,and the average length of hospital stay was 14.37 days;the average hospitalization fee for female patients was 24,913.86 yuan,and the average length of hospital stay was 15.09 days;for patients of different age groups,less than 44 years old.The average cost of hospitalization was 27,877.98 yuan,and the average length of hospitalization was 13.50 days.The average cost of hospitalization for the 45-to 59-year-old group was 28,495.53 yuan,and the average length of hospitalization was 14.87 days and the average hospitalization cost for the 60-74-year-old group was 25,081.46 yuan.The average number of days of hospitalization was 15.02 days;the average cost of hospitalization for patients aged 75 and over was 18,499.45 yuan,and the average length of hospital stay was 14.59 days.Between 2014 and 2016,there were 4542 male patients with ischemic stroke and 3015 female patients.The average age of hospitalized patients was(68.85±10.92)years.The average age of male patients was(68.52±11.44)years and the average age of female patients was(69.35±10.07).At the age of majority,the patients were mostly concentrated in the elderly population.In these three years,the hospitalization costs of patients with ischemic stroke showed an overall upward trend,and the total cost of hospitalization was(9963.23±5787.80)yuan.Among the different sexes,the average hospitalization cost for male patients was 10,132.18 yuan,and the average length of hospital stay was 11.11 days;the average hospitalization fee for female patients was 1,970.73 yuan,and the average length of hospital stay was 10.46 days.Among the different age groups,the average cost of hospitalization for patients younger than 45 years was 12194.36 yuan,and the average length of hospital stay was 11.59 days.The average hospitalization fee for patients aged 45 to 59 years was 10371.373 yuan,and the average length of hospital stay was 10.65 days.The 60 to 74 year-old patients' average annual hospitalization fee for patients in the old group was 10002.14 yuan,and the average length of hospital stay was 10.84 days.The average hospitalization fee for patients aged 75 and above was 9575.52 yuan,and the average length of hospital stay was 10.92 days.ii.)The internal composition of hospitalization expenses for patients with stroke: From 2014 to 2016,drug costs were the main impact factors influencing the internal composition of hospitalization expenses for patients with hemorrhagic stroke.The examination fee ranked second and the consumable expense was the third influence,which are consistent with the changes in the structure of hospitalization costs for patients with hemorrhagic stroke.For ischemic stroke,drug costs,examination fees,and treatment costs are the top three factors that affect the cost of hospitalization for patients with ischemic stroke.During this period,drug costs,medical consumables,and examination fees for hospitalization costs Structural changes have a great influence.iii.)Attention cost of stroke patients External factors: The length of stay,surgery,age,complications or concomitant diseases,and payment methods are common for hospitalization expenses for patients with hemorrhagic and ischemic stroke after the influence of mixed factors is excluded.Influencing factors and admission pathways are the single influencing factors for patients with ischemic stroke.iv.)Case mix analysis: a regression model tree method was used to establish a case-combined model for the hospitalization expenses of patients with hemorrhagic and ischemic stroke respectively.After testing,the heterogeneity among the groups was strong,and the homogeneity within the group was good.The classification node was tested by using the ROC curve,and the AUC was greater than 0.5.Conclusion: i.Drug costs,examination fees,treatment fees,and consumables fees are the influencing factors for the internal composition of hospitalization costs for patients with stroke,and they have a greater impact on the structural changes in hospitalization costs for patients with stroke.It is important to pay attention to adjusting the structure of hospitalization expenses.ii.There was a positive correlation between hospitalization days and hospitalization costs.Shortening hospital stays can reduce hospitalization costs.iii.The middle-aged and old men are high-risk groups with stroke.The cost of hospitalization for young patients is higher than that for middle-aged and elderly patients.The economic burden of young patients is heavier.iv.The medical insurance payment method can reduce the patient's hospitalization cost,and shows its superiority in controlling the increase of hospitalization expenses.v.Case group classification results show that the grouping effect is reasonable,but the selection of classification nodes needs further optimization.By calculating the excess fees and the number of excess cases,a small number of excess patients consume most of the medical resources. |
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