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  本文關鍵詞：面向DRG的集成化醫(yī)療服務成本管理模式與方法研究　出處：《天津大學》2013年博士論文　論文類型：學位論文

  更多相關文章： 診斷相關組 醫(yī)療服務 集成化管理 成本預測 成本控制

【摘要】：本文從集成化管理的角度研究面向DRG的醫(yī)療服務成本管理，針對醫(yī)療服務成本管理研究現(xiàn)狀和我國醫(yī)院推行DRG存在的實際成本管理問題，應用集成化、系統(tǒng)化的思想，，研究了面向DRG的集成化醫(yī)療服務成本管理的基本理論和管理模式，并針對病種成本預測和控制的特點及存在的問題進行了深入研究，主要研究成果如下： 第一，對當前國內外關于醫(yī)療服務成本管理的研究文獻進行了分類、分析和評述，進而論述了目前醫(yī)療服務成本管理的主要研究方向，并在此基礎上提出了本文所要研究的主要問題。 第二，分析了DRG對醫(yī)療服務成本管理的影響，研究并分析了面向DRG的集成化醫(yī)療服務成本管理的體系結構、特征，構建了實施面向DRG的集成化醫(yī)療服務成本管理的理論框架，然后，在此基礎上，提出并構建了面向DRG的集成化醫(yī)療服務成本管理模式的框架模型，并對系統(tǒng)框架的構成和特征進行了詳細的說明。 第三，根據(jù)病種成本管理的需要，建立病種成本數(shù)據(jù)倉庫模型。然后，基于類物料清單（GBOM）構建了單病種及病種系列成本影響因素表達模型，并進行數(shù)學描述。最后，運用粗糙集理論構建了病種成本影響因素約簡模型，并進行了應用研究。 第四，針對病種成本預測方法展開研究。首先，提出了基于知識發(fā)現(xiàn)（KDD）的病種成本預測系統(tǒng)框架。然后，重點研究了基于SVM的單病種成本預測方法和基于PSO優(yōu)化SVM的DRG病種系列成本預測方法。 第五，針對病種成本控制方法展開研究。首先，將預測控制的思想引入病種成本控制，提出了病種成本預測控制的模式。然后，將EWMA控制圖和LSSVM引入病種成本控制，建立了基于EWMA控制圖和LSSVM的病種成本預測控制模型和基于GA優(yōu)化LSSVM的病種成本差異識別模型。 第六，面向成本的醫(yī)療服務運營優(yōu)化策略。在分析我國醫(yī)療服務運營存在的問題的基礎上，從醫(yī)院設施和人員配置的角度運用排隊論、系統(tǒng)仿真以及整數(shù)規(guī)劃等方法研究降低病種成本的策略。
[Abstract]:This paper studies the DRG oriented medical service cost management from the perspective of integrated management. Aiming at the current research situation of medical service cost management and the actual cost management problems existing in the implementation of DRG in Chinese hospitals, the application of integration. Based on the systematic idea, the basic theory and management model of integrated medical service cost management for DRG are studied, and the characteristics and problems of disease cost prediction and control are deeply studied. The main findings are as follows: First, the research literature on medical service cost management at home and abroad has been classified, analyzed and commented, and then discussed the main research direction of medical service cost management. On this basis, the main problems to be studied in this paper are put forward. Secondly, this paper analyzes the impact of DRG on the cost management of medical services, studies and analyzes the architecture and characteristics of integrated cost management of medical services for DRG. The theoretical framework of implementing integrated medical service cost management for DRG is constructed, and then, on this basis, the framework model of integrated medical service cost management model oriented to DRG is proposed and constructed. The structure and characteristics of the system framework are explained in detail. Thirdly, according to the need of disease cost management, the data warehouse model of disease cost is established. Then, based on the GBOM, the expression model of single disease and disease series cost influencing factors is constructed. Finally, using rough set theory to construct the reduction model of the factors affecting the disease cost, and carry on the application research. In 4th, the cost forecasting method of disease species was studied. Firstly, the framework of disease cost forecasting system based on KDD was proposed. The cost forecasting method of single disease based on SVM and series cost forecasting method of DRG disease based on PSO optimization SVM were studied. In 5th, the method of disease cost control was studied. Firstly, the idea of predictive control was introduced into disease cost control, and the model of disease cost predictive control was put forward. EWMA control chart and LSSVM were introduced into disease cost control. The predictive control model of disease cost based on EWMA control chart and LSSVM and the differential identification model of disease cost based on GA optimized LSSVM were established. 6th, a cost-oriented optimization strategy for medical service operation. Based on the analysis of the problems existing in the operation of medical services in China, the queuing theory is applied from the perspective of hospital facilities and staffing. System simulation and integer programming are used to study the strategies to reduce the cost of disease.
【學位授予單位】：天津大學
【學位級別】：博士
【學位授予年份】：2013
【分類號】：R197.32

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