Study On The Diagnosis Related Groups Of Hospitalization Expenses For Patients With Percutaneous Coronary Intervention

Objective and SignificanceThrough analysis the hospitalization expenses of patients with percutaneous coronary intervention,and further exploring the influencing factors of expenses,the diagnosis related groups models were established.It provides reference for the formulation of percutaneous coronary intervention diagnosis related groups in Shandong Province.It also can be conducive to the reasonable allocation and efficient use of medical insurance funds,and help to reduce the economic burden of patients as well.MethodsThis study collected home page of inpatient medical records of all patients with percutaneous coronary intervention in a 3A grade hospital in Shandong Province from 2016 to 2019.It mainly included the information of gender,age,marriage,admission route,length of stay,major diagnosis,secondary diagnosis,disease outcome,total hospitalization expenses and various specific expenses,etc.SPSS statistical software was used for data analysis.Two methods were used to analyze the influencing factors of hospitalization expenses.Nonparametric test method was used for single factor analysis,and multiple linear regression method was used for multiple factor analysis.Then,a case-mix model was constructed by CHAID decision tree method.Finally,the effect of this case-mix model was evaluated by coefficient of variation(CV),variance reduction(RIV)and non-parametric testing methods.ResultsOf the 8111 inpatients with percutaneous coronary intervention in this study,5724 cases(70.6%)were male and 2387 cases(29.4%)were female.Significantly,male patients were the majority.Among these patients,included 4851 cases(59.8%)aged 60 years or above.Most of the patients were elderly.From high to low,the components of the total hospitalization expenses were ranked according to the proportion,including sanitary material expenses,treatment expenses,western medicine expenses and laboratory test expenses,among which sanitary material expenses were the highest,accounting for 65.7%.The total hospitalization expenses increased from 108 million yuan in 2016 to 135 million yuan in 2019,and the average hospitalization expenses increased from 56,400 yuan to 58,800 yuan,showing an increasing trend.The results of univariate analysis showed that gender,age,disease outcome,comorbidities and complications,and the number of implanted stents had significant impact on hospitalization expenses(P<0.05).The results of multiple linear regression analysis showed that the factors affecting hospitalization expenses were the number of implanted stents,comorbidities and complications,disease outcome,gender and age in order of importance.According to these results,the important influencing factors were included as predictive variables,and the total cost of hospitalization was taken as the target variable.Finally,a total of 10 case-mix results were formed by the CHAID decision tree method.The national standards require that the cost difference between the subdivided diagnosis-related groups is not less than 20%,and 6 of the above 10 case-mix results met the national requirements.The effect evaluation of the case-mix models showed that CV was less than 1 and RIV was 41.20%.Meanwhile,K-S test was statistically significant(P<0.001).Therefore,the case-mix models had strong inter-group heterogeneity and intra-group homogeneity,and we believe that the case-mix models formed in this study had a good effect.ConclusionThe total hospitalization expenses of patients with percutaneous coronary intervention showed an increasing trend these years.The number of stents implanted had the greatest impact on the cost of hospitalization.Patients with percutaneous coronary intervention were mostly male over 60 years old.The more implanted stents,the more complications and complications were associated with the higher hospitalization expenses.The effect evaluation showed that diagnosis related groups models established in this study were reasonable and effective.