| Objectives: To analyze the hospitalization expenses of elderly and non-elderly coronary heart disease patients in tertiary hospitals in Lanzhou City from 2013 to 2016,to understand the socioeconomic characteristics and clinical characteristics of patients with coronary heart disease at different ages;to grasp the overall trend of hospitalization expenses for patients with coronary heart disease;To explore the composition of hospitalization expenses and the influencing factors of patients with coronary heart disease;on the basis of the above,the decision tree model in data mining was used to conduct the diagnosis related groups(DRGs)of elderly and non-elderly coronary heart disease patients;According to the relevant algorithm,the standard hospitalization expenses of different groups were established,and the number of hospitalization expenses exceeding the standard in different groups was counted,so as to clear the over-standard rate of hospitalization expenses for patients with coronary heart disease in Lanzhou City.It provides a reference for the implementation of scientific and reasonable payment methods for DRGs,effective control of the increase in hospitalization costs for patients with coronary heart disease,reduction of the economic burden of patients,and mitigation of the status quo of “poor illness due to illness”.Methods: The home information of the discharged patients' medical records of Lanzhou Hospital from January 1,2013 to December 31,2016 was obtained from the Ganyu Provincial Health and Family Planning Statistics Information Network Direct Reporting System.14430 cases of coronary heart disease patients(the first three I20-I25 encoded by ICD-10)were filtered outfrom the datebase of tertiary hospital in Lanzhou City.According to the national classification criteria for the elderly,patients with coronary heart disease were divided into the elderly group(?60 years old)and non-elderly groups(<60 years old),Descriptive analysis of socioeconomic characteristics and clinical features of elderly and non-elderly coronary heart disease patients;gray correlation analysis and structural change analysis method were used to analyze the composition of hospitalization expenses for elderly and non-elderly coronary heart disease patients;single factor analysis,multiple linear regression analysis and path analysis method by SPSS22.0 were used to study the influencing factors of hospitalization expenses for elderly and non-elderly coronary heart disease patients.The decision tree model algorithm was used to analyze the DRGs cases in elderly and non-elderly coronary heart disease patients,and the standard hospitalization expenses of different groupings were calculated.Results:(1)The basic situation of patients with coronary heart disease: There were 9530 elderly patients with coronary heart disease and 4900 other coronary heart disease patients.The number of elderly patients with coronary heart disease decreased in 2016,which was consistent with the overall trend,while the number of other patients with coronary heart disease increased year by year;The average age of elderly patients with coronary heart disease(72.12±7.94)years old,the average age of non-elderly coronary heart disease patients(51.45±6.14)years old,the average age of the disease showed a downward trend,facing the risk of rejuvenation;There were more male patients with coronary heart disease than females,accounting for 61.77% and 38.23% of the total number of patients with coronary heart disease in this study.(2)The basic situation of hospitalization expenses for patients with coronary heart disease: the overall hospitalization cost of patients with coronary heart disease(17062.13±17776.242)yuan,of which the hospitalization cost of elderly patients with coronary heart disease(16149.34±17165.29)yuan is lower than that of non-elderly coronary heart disease patients(18837.42).±18783.22);the hospitalization cost of elderly patients with coronary heart disease showed an increasing trend year by year,the average growth rate exceeded 10%;the hospitalization expenses of non-elderly coronary heart disease patients decreased first and then increased,the increase rate was much greater than the decline;The average hospitalization cost of acute myocardial infarction was the highest,and the total hospitalization cost of stable ischemic heart disease was the lowest.(3)The composition of hospitalization expenses for patients with coronary heart disease: medical service fee,drug fee and diagnosis fee are the main factors affecting the hospitalization expenses of elderly patients with coronary heart disease,which is the same as that of non-elderly coronary heart disease patients;The most significant impact on the changes in the hospitalization cost structure of elderly patients with coronary heart disease is the consumables fee,followed by the diagnostic fee,and the third is the treatment fee;the most significant impact on the changes in the hospitalization cost structure of non-elderly coronary heart disease patients is the medical service fee,followed by the consumables fee.The third is the treatment fee.(4)Analysis of influencing factors of hospitalization expenses for patients with coronary heart disease: The common influencing factors of elderly and non-elderly coronary heart disease patients are gender,occupation,payment method,length of hospital stay,whether surgery,blood transfusion or disease classification;age,unmarried,No comorbidity is the single influencing factor in elderly patients with coronary heart disease;Pathway analysis showed that the top three factors in the total cost of hospitalization for elderly patients with coronary heart disease were surgery,length of hospital stay,stable ischemic heart disease in disease classification;The number of hospital stays,acute myocardial infarction in disease classification,and gender were among the top three in the total effect of hospitalization expenses for non-elderly coronary heart disease patients.(5)The group homogeneity and inter-group heterogeneity of DRGs patients in coronary heart disease patients were better,and the grouping was reasonable;14 DRGs group were formed in the case combination of elderly patients with coronary heart disease,and a total of 8 DRGs were formed in non-elderly coronary heart disease patients.Conclusions:(1)The average hospitalization cost and individual expenses of patients with coronary heart disease have this phenomenon,and the overall hospitalization expenses are on the rise.It is imperative to control the increase of hospitalization expenses and optimize the hospitalization expenses structure.(2)Medical service fees,diagnostic fees,drug charges,consumables fees,and treatment fees are important factors influencing the composition and structural changes of hospitalization costs for coronary heart disease.These costs should be emphasized in controlling the increase in hospitalization costs and optimizing the cost structure.(3)There are few patients with acute myocardial infarction,but the hospitalization cost is the highest;the stable ischemic heart disease patients have the most,but the hospitalization expenses are the lowest.Therefore,focus should be placed on controlling the cost of hospitalization for both types of disease in terms of quality and quantity.(4)The hospitalization cost of non-elderly coronary heart disease patients is higher than that of elderly patients with coronary heart disease,and the hospitalization cost of male patients is higher than that of female patients.(5)The number of hospital stays was positively correlated with the hospitalization expenses.The hospitalization expenses of surgical patients were higher than those of non-surgical patients.The hospitalization expenses of transfusion patients were higher than those of non-transfusion patients,which was consistent with other related research results.(6)Whether surgery,hospitalization days,stable ischemic heart disease have a greater total effect on hospitalization costs for elderly patients with coronary heart disease,gender,length of hospital stay,acute myocardial infarction have a greater overall effect on hospitalization costs for non-elderly coronary heart disease patients.(7)The results of the combined cases of elderly and non-elderly coronary heart disease patients are reasonable,but there are more cases exceeding the standard,and it is necessary to control the fees according to different grouping standard hospitalization expenses. |
PDF Full Text Request