Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2484-2493
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2484
Research on diagnosis-related group grouping of inpatient medical expenditure in colorectal cancer patients based on a decision tree model
Suo-Wei Wu, Qi Pan, Tong Chen
Suo-Wei Wu, Qi Pan, Tong Chen, Department of Medical Administration, Beijing Hospital, Beijing 100730, China
Author contributions: Wu SW and Pan Q performed the research; Chen T designed the study; Wu SW wrote the paper; Pan Q revised the manuscript.
Institutional review board statement: This study was reviewed and approved by the Beijing Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tong Chen, MD, Professor, Department of Medical Administration, Beijing Hospital, No. 1 Dahua Road, Dongdan, Dongcheng District, Beijing 100730, China. chentong@bjhmoh.cn
Received: February 26, 2020
Peer-review started: February 26, 2020
First decision: March 31, 2020
Revised: May 25, 2020
Accepted: May 30, 2020
Article in press: May 30, 2020
Published online: June 26, 2020
Abstract
BACKGROUND

In 2018, the diagnosis-related groups prospective payment system (DRGs-PPS) was introduced in a trial operation in Beijing according to the requirements of medical and health reform. The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance. Colorectal cancer (CRC), as a common malignant tumor with high prevalence in recent years, was among the 300 disease types.

AIM

To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs, and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.

METHODS

The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system. A variance analysis of the composition of medical expenditure was carried out, and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance. A decision tree model based on the exhaustive χ2 automatic interaction detector (E-CHAID) algorithm for DRG grouping was built by setting chosen factors as separation nodes, and the payment standard of each diagnostic group and upper limit cost were calculated. The correctness and rationality of the data were re-evaluated and verified by clinical practice.

RESULTS

The average hospital stay of the 1026 CRC patients investigated was 18.5 d, and the average hospitalization cost was 57872.4 RMB yuan. Factors including age, gender, length of hospital stay, diagnosis and treatment, as well as clinical operations had significant influence on inpatient expenditure (P < 0.05). By adopting age, diagnosis, treatment, and surgery as the grouping nodes, a decision tree model based on the E-CHAID algorithm was established, and the CRC patients were divided into 12 DRG cost groups. Among these 12 groups, the number of patients aged ≤ 67 years, and underwent surgery and chemotherapy or radiotherapy was largest; while patients aged > 67 years, and underwent surgery and chemotherapy or radiotherapy had the highest medical cost. In addition, the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated.

CONCLUSION

It is important to strengthen the control over the use of drugs and management of the hospitalization process, surgery, diagnosis and treatment to reduce the economic burden on patients. Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.

Keywords: Diagnosis-related groups, Health care cost, Colorectal cancer, Length of stay

Core tip: This study analyzed the influencing factors on inpatient medical expenditure in colorectal cancer patients and the grouping results of diagnosis-related groups (DRGs) payment. A decision tree model based on the exhaustive χ2 automatic interaction detector algorithm for DRG grouping was built by setting chosen factors as separation nodes, and the payment standard of each diagnostic group and upper limit cost were calculated. By reorganizing and verifying the grouping payment standards through the practical study of real cases, the study provided a theoretical basis and validation methodology for the full implementation of DRGs payment management.