| ObjectiveIn this study,the wound care costs for burn patients in the outpatient department were calculated and the influencing factors were analyzed.On this basis,the Decision Tree was applied to construct a predictive model of wound care costs for burn patients in the outpatient department.It aimed to lay a foundation for the wound care of burn patients’ wound care packaged charging in the outpatient department,and provided data support for reasonable pricing of burn patients in the outpatient department.MethodsThis study was a cross-sectional study.Using the convenience sampling method,328 burn patients in the outpatient department who attended the Wound Center of a tertiary hospital from July 2020 to December 2020 were selected as the research objects.The questionnaire survey method was used to collect general information of burn patients in the outpatient department,wound conditions,time and materials consumed for dressing change,the department equipment prices,the usage time and frequency,and the nurses’ salaries,etc.,so as to calculate the wound care costs and actual charges.The single factor analysis and multiple linear regression analysis were used to explore the influencing factors of wound care costs.Randomly selecting 80%(262 cases)sample size,this study used the Decision Tree Chi-Square Automatic Interaction Detector(CHAID)algorithm to establish the prediction model grouping of burn patients’ wound care costs in the outpatient department,used the coefficient of variation and analysis of variance to evaluate the effect of the model grouping,and determined the prediction model standard costs and upper costs limit for grouping.Finally,another 20%(66 cases)sample size was used to test the accuracy of the model grouping.Results(1)The normality test showed that wound care costs were non-normally distributed.Therefore,this study used the median to represent the average level of wound care costs and actual charges.The results showed that the average nursing cost for burn patients in outpatient department was 288.02 yuan and the average charge was 350.00 yuan.The difference was 61.98 yuan,and the difference was statistically significant(p<0.05).The six elements that make up the cost of wound care include labor costs,material costs,equipment depreciation costs,operating costs,administrative costs,and teaching and research costs.The results showed that the above 6 factors accounted for53%,8%,7%,23%,4% and 5% of wound care costs respectively.(2)The results of single factor analysis showed that different medical cost payment methods,combined disease status,wound course,the number of dressing changes,wound location,the number of wounds,wound infection,the surface area of the wound,burn depth,wound exudate volume,the type of wound tissue,surrounding skin condition,and wound outcome had impacts on the wound care costs.The results of multiple linear regression analysis showed that wound exudate volume,burn depth,the number of wounds,wound infection,surrounding skin condition and the surface area of the wound affected the wound care costs.(3)Using the Decision Tree CHAID algorithm,wound care costs were taken as the target variable,and the meaningful results obtained from the multi-factor analysis were used as input variables.Finally,a total of 10 predictive model groups were established.Each group was evaluated,and the results showed that the maximum CV value was 13.48% and the minimum was 3.13%,indicating that the homogeneity within the group was better.Meanwhile,the results of the analysis of variance showed that the difference between the 10 groups was statistically significant(p<0.05).With reference to foreign standard costs and cost ceiling formulation methods,the standard costs and cost ceilings for 10 groups were formulated.The results showed that the maximum standard cost of 10 groups was 1169.31 yuan and the minimum was 83.47 yuan,the maximum cost was 1970.03 yuan and the minimum was 185.51 yuan,and3% of patients’ wound care costs exceeded the upper cost limit.The result of the model test showed that its prediction accuracy is 98.03%,indicating that the model can better predict the wound care costs of the burn patients in the outpatient department.Conclusions(1)The wound care costs of the burn patients in the outpatient department were lower than the actual charges,and the labor costs accounted for the highest proportion of the wound care costs.It can be seen that there are problems with the wound care charges for the burn patients in the outpatient department.It is necessary to strengthen the research on wound care costs to achieve reasonable charges for burn patients in the outpatient department.Moreover,strengthening the control of the labor costs is conducive to reducing wound care costs.(2)Factors such as wound exudate volume,burn depth,the number of wounds,wound infection,surrounding skin condition and the surface area of the wound affected the wound care costs.In clinical practice,the wound care process should be standardized to reduce the wound care costs.(3)A predictive model of wound care costs for burn patients in the outpatient department was established based on the wound exudate volume,burn depth,the surface area of the wound,surrounding skin condition and the number of wounds.This study applied the Decision Tree into the wound care costs for burn patients in the outpatient department,which not only provided a reference for the formulation of cost standards for burn patients in the outpatient department,but also laid the foundation on packaged charging for burn patients in the outpatient department.In the future,clinicians can refer to the ideas and methods above to implement packaged charges for wound care of burn patients in the outpatient department. |
