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
Processing time: 118 Days and 19.9 Hours
ARTICLE HIGHLIGHTS
Research background

In 2018, the diagnosis-related groups prospective payment system (DRGs-PPS) was introduced in a trial operation that required more than 300 disease types pay through the DRGs-PPS for medical insurance in Beijing.

Research motivation

The study investigated the composition and factors related to inpatient medical expenditure in colorectal cancer (CRC) patients based on disease DRGs, and provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.

Research objectives

In practice, the basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected.

Research methods

Variance analysis of the composition of medical expenditure as well as the multivariate linear regression model were used to select influencing factors. Then, a decision tree model based on the 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, while the correctness and rationality of the data were re-evaluated and verified by clinical practice.

Research results

Results showed that 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 a significant influence on inpatient expenditure. Age, diagnosis, treatment, and surgery were adopted as the grouping nodes in building the decision tree model, and the CRC patients were divided into 12 DRGs cost groups, the standard cost and upper limit cost of each group were calculated and re-evaluated.

Research conclusions

The study provided a practical methodology for the practical implementation of the DRGs-PPS and enhanced the comprehensiveness and practicability in cost control management.