Objective:To optimize the grouping of the fundus surgery treatment group(CB1)in Shanghai by drawing on the Australian episode clinical complexity(ECC)model,and to propose a grouping improvement plan.Methods:CB1 data were collected from 21 hospitals in Shanghai from survey;case cost relationship functions were constructed using MATLAB,and Treatment Complexity Level(TCL)&Episode Clinical Complexity Score(ECCS)were computed;the quantified ECCS were classified into a decision tree using SPSS 24.0;the results were evaluated and examined using the Coefficient of Variation(CV),Reductio in Variance(RIV),and Kruskal-Wallis test.Results:CB1 were categorized as mildly complex(CV 0.65),moderately complex(CV 0.39),and severely complex(CV 0.30),RIV= 0.61,P＜0.01,which was in line with the requirement of the norms of independent grouping.Conclusion:On the basis of CB1 group,applying the ECC model with operation as independent variables can further reflect episode complexity level,improve the grouping performance,and better meet the needs of health insurance payment and performance evaluation.The proposed grouping scheme based on the results of the study has been adopted by the Municipal Health Insurance Bureau,providing a decision-making basis for local dynamic adjustment of DRGs grouping.
Diagnosis Related Groupepisode clinical complexityfundus surgeryMATLAB
NETL
NSTL
万方数据
