首页|基于决策树模型的中医特色医保付费方式研究——以结直肠恶性肿瘤为例

基于决策树模型的中医特色医保付费方式研究——以结直肠恶性肿瘤为例

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目的:以结直肠恶性肿瘤住院患者为例,探索适合中医医疗机构的医保付费方式.方法:使用2021年北京市部分中医及综合医院住院患者病案首页数据,选取结直肠恶性肿瘤病例28083例.采用非参数检验、多元线性回归分析确定住院费用影响因素,以决策树模型构建病组分组方案.结果:以是否手术、其他诊断数量和中医治疗费用占比等8个费用影响因素作为住院费用分类节点纳入决策树模型,形成12个病例组,CV及RIV值显示分组结果较好.结论:将代表中医特色的指标"中医治疗费用占比"作为分类节点纳入分组模型,能够得到体现中医特色的结直肠恶性肿瘤治疗分组方案,为建立适合中医医疗机构的医保付费方式提供参考.
Research on TCM Characteristic Payment Method Based on Decision Tree Model——Taking Colorectal Cancer as an Example
Objective:Taking inpatients with colorectal cancer as an example,the paper explores a suitable medical insurance payment method for traditional Chinese medicine(TCM)medical institutions.Methods:28083 cases of colorectal malignant tumors were selected from the medical records of inpatients from some TCM and comprehensive hospitals in Beijing in 2021.Non-parametric testing and multiple linear regression analysis were used to determine the influencing factors of hospitalization costs,and decision tree model was used to construct the grouping plan.Results:8 influencing factors,including surgery,number of diagnoses and the proportion of TCM treatment costs,were included as classification nodes in the decision tree model to form 12 case groups.The CV and RIV values showed good grouping results.Conclusion:By incorporating the indicator"proportion of TCM treatment costs"representing the characteristics of TCM as a classification node into the grouping model,a treatment grouping plan for colorectal cancer that reflects the characteristics of TCM can be obtained,which can provide a reference for establishing medical insurance payment methods suitable for TCM medical institutions.

TCM characteristicsmedical insurance payment methodcolorectal cancerdecision tree

郭慧君、杨宇飞、徐钰莹、刘晶、王雪杰、李秋艳

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中国中医科学院西苑医院 北京 100091

中医特色 医保付费方式 结直肠恶性肿瘤 决策树

北京市中医管理局中医药服务与发展专项首都医科大学国家医保研究院开放性课题

04-154YB2023B07

2024

中国医疗保险
中国医疗保险研究会

中国医疗保险

影响因子:0.492
ISSN:1674-3830
年,卷(期):2024.(4)
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