【摘要】 目的通过分析北京市心肌梗死介入治疗患者的医疗费用及其影响因素,探索一种较为科学合理的打包付费分组标准及偿付标准,为医疗保险机构制定合理的医疗保险支付方式及偿付标准提供科学合理的参考。方法收集北京市38家三甲医院2009年9月至2011年9月心肌梗死介入治疗患者的基本信息与费用结算信息,分别从影响医疗费用的社会学因素、临床因素和疾病因素三个方面选取有代表性的指标纳入决策树分析,采用CHAID决策树方法构建疾病的病例分组,并制定出各疾病分组的偿付标准。结果将年龄、性别、住院天数、是否发生再入院、疾病诊断、是否发生出院后门诊,以及并发症作为研究的影响因素纳入CHAID决策树,而经CHAID决策树分析后有六个变量(年龄、疾病诊断、高血压、高脂血症、2型糖尿病、心源性休克)纳入病例组合模型,该模型一共包括20个病例组。结论针对北京市心肌梗死介入治疗患者医疗费用的影响因素制定打包付费分组标准及偿付标准是可行的,可为医疗保险机构制定打包付费相关政策提供参考。更多还原

【Abstract】 Objective To analyze the medical expenses and its influencing factors of the patients with myocardial infarction in Beijing, and to explore a scientific and reasonable bundle payment standard and reimbursement standard, and to provide a scientific and reasonable reference for medical insurance organizations to make reasonable payment methods and reimbursement standards. Methods We collected the basic information and cost information of patients who received interventional therapy of myocardial infarction in 38 hospitals in Beijing from September 2009 to September 2011. We included several representative indexes from three aspects which affected medical expenses, including sociological factors, clinical factors and disease factors to decision tree analysis. We used CHAID decision tree method to construct the method of case grouping, and to establish reimbursement criteria for each disease group. Results We included age, sex, hospitalization days, readmission or not, disease diagnosis, outpatient after discharge or not, and complications as research factors into the CHAID decision tree. Finally, we got six variables after CHAID decision tree analysis in the model of case grouping, including age, disease diagnosis, hypertension, hyperlipidemia, type 2 diabetes mellitus, cardiac shock. A total of 20 case groups were established after analysis. Conclusion It is feasible to set up the bundle payment grouping standard and reimbursement standard targeting the factors influencing the medical expenses of patients with myocardial infarction in Beijing. It may provide a reference for the medical insurance institution to construct related policy of bundle payment.更多还原