本文選題：原發(fā)性肝癌 + 結(jié)構(gòu)分析��； 參考：《東南大學(xué)》2017年碩士論文

【摘要】：目的:了解2014、2016、2016三年間南京市某三甲醫(yī)院原發(fā)性肝癌首次住院手術(shù)患者基本情況以及3年內(nèi)住院診療總費用的變化趨勢;本文運用新灰色關(guān)聯(lián)分析法和結(jié)構(gòu)變動分析法等分析原發(fā)性肝癌住院手術(shù)患者診療總費用的內(nèi)部影響因素,描述各費用項目與診療總費用之間的關(guān)聯(lián)及其密切程度,并對其影響力的大小進行排序;通過統(tǒng)計分析對影響住院患者診療總費用的外部因素進行篩選,提取出有意義的變量并進行多重線性回歸分析,指出醫(yī)療費用增長中的可控因素;同時利用分類回歸樹算法,嘗試進行病例分組和合理費用測算,為病種模型的建立提供一定的方法學(xué)的參考,并為合理控制住院費用增長、保障醫(yī)保基金安全運行、減輕病人疾病負擔提供科學(xué)的建設(shè)意見。方法:本研究中選擇南京市某三甲醫(yī)院2014、2015、2016三年間原發(fā)性肝癌首次住院手術(shù)病人的住院期間費用明細和出院病案首頁部分信息兩部分資料作為研究樣本資料,經(jīng)過嚴格準入及對異常信息的整理得到合理有效樣本數(shù)為912例。根據(jù)物價指數(shù)CPI的漲幅和變動,選擇基線后對診療費用進行合理調(diào)整,分析原發(fā)性肝癌住院手術(shù)患者診療費用的整體情況,分析住院診療總費用的內(nèi)部結(jié)構(gòu)、內(nèi)部影響因素以及外部影響因素;然后,在原發(fā)性肝癌住院手術(shù)病人的診療費用影響因素的分析和前期所進行的文獻研究,在借鑒國際上腫瘤類重大疾病支付管理的實踐和經(jīng)驗基礎(chǔ)上,應(yīng)用決策樹中分類回歸樹的算法建立初步的病例組合模型,并探討DRGs支付方式的合理性,嘗試制定出不同病組按病種付費的科學(xué)標準。結(jié)果:1、原發(fā)性肝癌住院手術(shù)病人平均人次費用為60310.59元,占該醫(yī)院原發(fā)性肝癌住院病人總費用中最高費用的類目依次為西藥類、耗材類、診斷類和手術(shù)治療類,其中西藥費最高,約占總費用的40%。2、新灰色關(guān)聯(lián)分析中發(fā)現(xiàn),西藥費的關(guān)聯(lián)度最大,其次為耗材類費用以及診斷類費用。結(jié)構(gòu)變動度分析中則提示,住院診療總費用的變化主要有診斷費、耗材類、西藥類費用引起,最高時三者合計貢獻率超過80%。3、住院費用受年齡、性別、合并癥、入院方式、住院天數(shù)、是否醫(yī)保患者、臨床分型分期等多種因素的影響;4、采用決策樹算法中分類回歸樹的方法將病例分別分組,無論從統(tǒng)計學(xué)的方法上,還是在臨床的具體實踐中,都具有較為合理的實際意義,結(jié)果可讀性較強;各組別得出的具體費用標準,可以為醫(yī)保決策機構(gòu)提供相關(guān)支付標準制定的依據(jù)。建議:1、當前原發(fā)性肝癌住院手術(shù)病人費用管理問題的根本,是要解決其缺乏規(guī)范化治療的問題,需要完善臨床路徑設(shè)計,推動疾病診斷和治療的合理化、規(guī)范化,提升重大疾病的診療水平和效果。2、探索建立合理的以DRGs為核心的新的醫(yī)保支付方式,推動腫瘤疾病支付制度的建立和完善,同時完善醫(yī)療衛(wèi)生服務(wù)系統(tǒng)的信息化建設(shè),為政策實踐和學(xué)術(shù)研究提供科學(xué)的依據(jù),也為推進支付方式改革提供暢通的渠道。3、通過合理控制本研究中統(tǒng)計分析所指出的影響因素,合理控制醫(yī)療衛(wèi)生服務(wù)費用的增長,以保證服務(wù)質(zhì)量為前提,同時注意防范道德風險。4、針對腫瘤疾病患者外購分子靶向藥物的情況,一方面要加速醫(yī)保談判,將合理需求納入醫(yī)保藥品目錄范圍,減輕患者疾病負擔,另一方面要正確引導(dǎo)患者的需求,避免盲目跟風,合理選擇治療方案。5、肝癌早發(fā)現(xiàn)、早診斷、早治療工作刻不容緩。
[Abstract]:Objective: to understand the basic situation of the first hospitalized patients with primary liver cancer in a three a hospital of Nanjing in 201420162016 and three, and the change trend of the total cost of hospitalization in 3 years. In this paper, the internal influence factors of the total cost of diagnosis and treatment for patients with primary liver cancer were analyzed by the new grey correlation analysis and structural change analysis. The relationship between the cost items and the total cost of diagnosis and treatment is described and the size of their influence is sorted. The external factors affecting the total cost of diagnosis and treatment in hospitalized patients are screened by statistical analysis, the meaningful variables are extracted and the multiple linear regression analysis is carried out, and the controllable factors in the growth of medical expenses are pointed out. At the same time, using the classification regression tree algorithm, try to carry out case grouping and reasonable cost calculation, provide a certain reference for the establishment of the disease model, and provide scientific advice for the rational control of the growth of hospitalization expenses, ensuring the safe operation of the medical insurance fund and alleviated the disease burden of the patients. Method: This study selected a three of Nanjing city. A hospital for the first time of 201420152016 three years of primary liver cancer for the first time in the hospital for the first time the cost of the hospital and the first page of the medical record part of the information two part of the data as the research sample data, after strict access and the arrangement of abnormal information to get reasonable and effective samples of 912 cases. According to the price index CPI increase and change, choose After a reasonable adjustment of the cost of diagnosis and treatment, the overall situation of the cost of diagnosis and treatment of the patients with primary liver cancer was analyzed, the internal structure of the total cost of hospitalization, the internal influence factors and the external factors were analyzed. On the basis of the practice and experience of international cancer disease payment management, a preliminary case combination model was established by using the algorithm of classified regression tree in the decision tree, and the rationality of the DRGs payment method was discussed. The scientific standards for the payment of disease types in different groups were made. Results: 1, primary liver cancer hospitalization operation. The average cost of the patient was 60310.59 yuan. The highest cost of the total cost of the primary liver cancer in the hospital was the western medicine, the consumables, the diagnosis and the surgical treatment, among which Western medicine was the highest, accounting for 40%.2 of the total cost, the new grey correlation analysis was found, the association of Western medicine was the largest, and the second was the cost of consumables. In the structural change degree analysis, the changes of the total cost of the hospital diagnosis and treatment were mainly the diagnosis fee, the consumables and the western medicine. The total contribution rate of the three persons was more than 80%.3, and the hospitalization expenses were affected by age, sex, complication, hospitalization days, medical insurance patients, clinical classification stages and many other factors. 4, using the method of classification regression tree in the decision tree algorithm, the cases are divided into two groups, both in statistical methods and in clinical practice, which have more reasonable practical significance and more readable results. The specific cost standards of each group can provide relevant payment standards for medical insurance policy making institutions. 1. The root of the cost management of the patients with primary liver cancer is to solve the problem of the lack of standardized treatment. It is necessary to improve the clinical path design, promote the rationalization and standardization of the diagnosis and treatment of the disease, improve the level and effect of the diagnosis and treatment of the major diseases.2, and explore the establishment of a reasonable DRGs core. The new payment method of medical insurance promotes the establishment and perfection of the payment system for cancer diseases, and improves the information construction of the medical and health service system, provides scientific basis for the policy practice and academic research, and provides a smooth channel for the reform of the payment mode of.3. In order to control the growth of medical and health service cost reasonably, in order to ensure the quality of service as the premise, and guard against the moral risk.4, on the one hand, the medical insurance negotiations should be accelerated and the reasonable demand should be incorporated into the range of medical insurance drugs to reduce the disease burden on the patients. On the other hand, it should be correctly cited. To guide the needs of patients, avoid blindly following the trend, and rationally choose treatment plan.5, early detection, early diagnosis and early treatment of liver cancer is urgent.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7;F842.684

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