| Objectives To explore the implementation effect of the CHS-DRGs payment system in Qingyang on the hospital expenses,out-of-pocket expenses,medical insurance compensation expenses,the proportion of out-of-pocket expenses and length of stay.According to the CHS-DRGs grouping scheme,the relevant evaluation indicators were used to analyze and demonstrate the case grouping in Qingyang,which provide a reference for establishing grouping scheme that are in line with local conditions.Methods We planned to use generalized linear regression model analyses to evaluate the implementation of CHS-DRGs in Qingyang on the hospital expenses,outof-pocket expenses,medical insurance compensation,proportion of out-of-pocket expenses,and length of stay.CV and RIV were used to screen ADRG groups that need to be regrouped.Univariate analysis,data mining techniques such as ANN and SVM were used to analyze the influencing factors of hospitalization expenses.The input variables were the main influencing factors that were screened out,and the output variable was the hospitalization cost.The Decision Tree is used to optimize case mix,and the optimization effect was evaluated.Results（1）The implementation of CHS-DRGs had no significant effect on the length of hospital stay.The empirical research of Qingyang showed that after the implementation of CHS-DRGs,hospitalization expenses,out-of-pocket expenses,its share of expenditure,medical insurance compensation expenses of inpatients all increased significantly（P<0.1）.（2）In the results of the ADRG grouping,the RIV of the MDCB and MDCG groups were 26.65% and 35.89%,respectively,with eleven and six ADRG groups having a CV value greater than 0.8.Finally,we chose neck or cerebrovascular surgery（BE1）,intracranial hemorrhagic disorders（BR1）,viral brain,spinal cord and meningitis（BT1）,other infections of the nervous system（BT2）,nervous system tumors（BU1）,epilepsy（BV1）,neurogenic muscle pain（BV2）,open craniocerebral injury（BY1）,closed head injury（BY2）,spinal cord injury and dysfunction（BY3）,other rectal surgery（GF2）,Other digestive system surgery（GJ1）,digestive ulcer with bleeding or perforation（GU1）,gastrointestinal obstruction or abdominal pain（CV1）,another digestive system diagnosis（GZ1）as the research objects of the case grouping.（3）Multivariate analysis showed that the SVM linear correlation coefficients of the training set of the MDCB group and MDCB group were 0.81 and 0.86,respectively,and the prediction effect was better;Finally,in MDCB group,the length of days,visittime,surgery,and leave-way were selected.In addition to the above factors,MDCG group also screened out combination and complication,gender,critical diseases,other diagnoses,and medical institution level as input for the next step research variable.（4）Decision Tree model found that the included influencing factors cannot build a decision tree grouping for patients in the MDCB group;For MDCG,the decision tree constructed by the CART algorithm was more accurate,with an accuracy rate of 71.50%;The MDCG group forms five DRG groups,the coefficient of variation of the groups was less than 0.5,the non-parametric test P<0.0001,the area under the ROC curve was greater than 0.5,the grouping meets the requirements.The results of setting the cost standard showed that: excess standard number accounted for 4.42% of the included study cases.Conclusions The CHS-DRGs payment system didn’t play a role in controlling fees,the burden of patients’ disease and pressure on the payment of medical insurance funds may continue to increase in Qingyang.The use of multiple methods for comparative analysis could effectively avoid the resulting bias caused by a single method.CART decision trees could be used as an effective research method for the optimization of DRGs grouping schemes.It was recommended to evaluate the implementation effect of CHS-DRGs in a timely manner,improve the information on the front of a medical record,optimize the case mix according to local conditions,and strengthen the detection and evaluation of the reform of payment so that DRGs payment system can better play an important role in basic medical insurance management and deepening medical reform,and promote the sustainable development of the medical service system in Qingyang. |
