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Cost Control of Treatment for Cerebrovascular Patients Using a Machine Learning Model in Western China
Siyu Zeng1, Li Luo1, Yuanchen Fang1
1Business School, Sichuan University, No. 24 South Section 1, Yihuan Road, Chengdu, China.
Insights
Including length of stay (LOS) in diagnosis-related groups (DRG) classification for cerebrovascular disease patients significantly reduces medical costs. This approach optimizes healthcare spending and improves cost control in China.
Area of Science:
- Health Economics
- Public Health
- Medical Informatics
Background:
- Cerebrovascular disease is a leading cause of death in China, necessitating urgent control of associated medical expenses.
- Diagnosis-related groups (DRG) are globally adopted for healthcare cost reduction, but regional variations in classification variables exist.
- The inclusion of length of stay (LOS) as a DRG classification variable remains a point of debate.
Purpose of the Study:
- To identify key factors influencing inpatient medical expenditure for cerebrovascular disease patients.
- To compare the performance of two DRG classification rule sets, with and without LOS.
- To evaluate the impact of controlling unreasonable medical treatment on cost savings.
Main Methods:
- Analysis of data from 45,575 inpatients in western China.
- Kruskal-Wallis H tests and multiple linear stepwise regression to identify cost influencers.
- Development of a chi-squared automatic interaction detector (CHAID) decision tree model for DRG grouping.
Main Results:
- Factors such as gender, age, insurance type, hospital level, LOS, surgery, outcomes, comorbidities, and hypertension significantly impacted inpatient costs (P < 0.05).
- DRG grouping with LOS resulted in seven groups, while without LOS yielded eight groups, requiring more clinical variables for comparable results.
- The DRG classification including LOS demonstrated a smaller coefficient of variation and lower upper cost limits, projecting annual savings of $3.35 million.
Conclusions:
- Incorporating LOS into DRG classification for cerebrovascular disease patients is effective for cost control.
- This approach optimizes healthcare resource allocation and reduces financial burden.
- The findings support the inclusion of LOS in DRG systems to enhance economic efficiency in managing cerebrovascular diseases.
Background:
Cerebrovascular disease has been the leading cause of death in China since 2017, and the control of medical expenses for these diseases is an urgent issue. Diagnosis-related groups (DRG) are increasingly being used to decrease the costs of healthcare worldwide. However, the classification variables and rules used vary from region to region. Of these variables, the question of whether the length of stay (LOS) should be used as a grouping variable is controversial.
Aim:
To identify the factors influencing inpatient medical expenditure in cerebrovascular disease patients. The performance of two sets of classification rules, and the effects of the extent of control of unreasonable medical treatment, were compared, to investigate whether the classification variables should include LOS.
Methods:
Data from 45,575 inpatients from a Healthcare Security Administration of a city in western China were used. Kruskal-Wallis H tests were used for single-factor analysis, and multiple linear stepwise regression was used to determine the main factors. A chi-squared automatic interaction detector (CHAID) algorithm was built as a decision tree model for grouping related data. The intensity of oversupply of service was controlled step by step from 10% to 100%, and the performance was calculated for each group.
Results:
The average hospitalization cost was 1,284 US dollars, and the total was 51.17 million US dollars. Of this, 43.42 million were paid by the government, and 7.75 million were paid by individuals. Factors including gender, age, type of insurance, level of hospital, LOS, surgery, therapeutic outcomes, main concomitant disease, and hypertension significantly influenced inpatient expenditure (P < 0.05). Incorporating LOS, the patients were divided into seven DRG groups, while without LOS, the patients were divided into eight DRG groups. More clinical variables were needed to achieve good results without LOS. Of the two rule sets, smaller coefficient of variation (CV) and a lower upper limit for patient costs were found in the group including LOS. Using this type of economic control, 3.35 million US dollars could be saved in one year.
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