基于决策树CHAID模型的桡骨远端骨折患者住院费用DRGs分组研究OA

Objective To establish a diagnosis-related groups(DRGs)system for distal radius fractures(DRF)based on the CHAID decision tree model,optimizing medical resource management and providing evidence-based support for medical insurance payment reform and clinical pathway optimization.Methods Retrospective analysis was conducted on 3136 DRF patient records from a tertiary hospital(2018-2023).Univariate analysis(Mann-Whitney U test)and multivariate analysis(multiple linear regression)were performed to identify factors influencing hospitalization costs.A DRG grouping model was then constructed using the CHAID algorithm.The grouping performance was evaluated using the Kruskal-Wallis H test,reduction in variance(RIV),and coefficient of variation(CV).Cost standards and disease weights were determined based on the median and Tukey's fences(Q3+1.5IQR).Results Based on the CHAID model,eight DRG groups were established(P＜0.01).The primary classification node was treatment modality,the secondary node was hospital day,and the tertiary node incorporated age grouping and presence of complications/comorbidities.Significant inter-group cost heterogeneity was observed(H=3135.00,P＜0.001),with a reduction in variance(RIV)of 72.50%and intra-group coefficient of variation(CV)ranging from 0.24 to 0.55,demonstrating effective grouping.Cost benchmarks were defined using median values and Q3+1.5IQR,and case-mix weights were calculated accordingly.DRG1(conservative treatment,hospital day≤8 days,no complications/comorbidities)exhibited the lowest mean cost(2942.24 yuan),while DRG8(surgical treatment,hospital day＞8 days,with complications/comorbidities)had the highest mean cost,which was 7.3 times that of DRG1,with a disease weight of 1.56,indicating the greatest consumption of medical resources.A total of 227 patients(7.24%)had hospitalization costs exceeding the upper limit,and the costs of these outlier cases accounted for 13.00%of the total costs.Conclusion The DRGs system established by the CHAID model accurately identifies cost-influencing factors,reduces hospitalization expenses through differentiated management,provides quantitative evidence for medical insurance payment reforms,and simultaneously promotes the optimization of clinical pathways and enhancement of healthcare quality for distal radius fractures,demonstrating significant health economics value.