基于诊断的风险调整方法对基于事件的成本进行比较,用于效率测量
Juyoung Kim1, Minsu Ock2, In-Hwan Oh3
1Department of Preventive Medicine, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea. juyoungkim0716@gmail.com.
BMC health services research
|December 1, 2023
概括
基于诊断的风险调整方法,特别是层次状况类别 (HCC),对于衡量医疗保健效率是有效的. 国家医疗保险服务 (NHIS) -HCC和卫生和人类服务部 (HHS) -HCC在基于事件的成本调整方面表现强.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
背景情况:
- 医疗保健支出不断增加,需要强大的效率和基于成本的绩效指标.
- 死亡风险调整方法需要进一步评估,以便在医疗保健中准确估计成本.
研究的目的:
- 为了比较各种基于诊断的风险调整方法对基于事件的成本的性能.
- 为了确定医疗保健效率测量的最佳方法.
主要方法:
- 使用了健康保险审查和评估服务-国家患者样本数据集.
- 在主要诊断类别 (MDC) 中开发了线性回归模型,包括人口统计,保险,机构类型,ADRG和风险调整方法 (RDRG,CCI,NHIS-HCC,HHS-HCC).
- 使用R平方,平均绝对误差和预测比率评估模型准确性,并对2017年数据进行外部验证.
主要成果:
- 精细诊断相关组 (RDRG) 的R平方从40.8%提高到45.8%.
- 与RDRG (45.8%) 和查尔森并发症指数 (CCI) (42.7%) 相比,等级状况类别 (HCC) 的表现更好 (NHIS-HCC调整R2为46.3%,HHS-HCC调整R2为45.9%).
- 模型性能因MDC而异;HCC在12个MDC中表现出色,RDRG在6. RDRG的平均绝对误差是最低的 (1099美元).
结论:
- 在基于情节的成本计算中,NHIS-HCC和HHS-HCC有效地调整并发症.
- 这些HCC方法可以可靠地用于医疗保健效率测量.
相关概念视频
Comparing the Survival Analysis of Two or More Groups
197
Survival analysis is a cornerstone of medical research, used to evaluate the time until an event of interest occurs, such as death, disease recurrence, or recovery. Unlike standard statistical methods, survival analysis is particularly adept at handling censored data—instances where the event has not occurred for some participants by the end of the study or remains unobserved. To address these unique challenges, specialized techniques like the Kaplan-Meier estimator, log-rank test, and...
197
Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
130
Biopharmaceutical studies constitute a vital field aiming to enhance drug delivery methods and refine therapeutic approaches, drawing upon diverse interdisciplinary knowledge. In research methodologies, the choice between controlled and non-controlled studies significantly influences the study's reliability and accuracy.
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
130
Kaplan-Meier Approach
152
The Kaplan-Meier estimator is a non-parametric method used to estimate the survival function from time-to-event data. In medical research, it is frequently employed to measure the proportion of patients surviving for a certain period after treatment. This estimator is fundamental in analyzing time-to-event data, making it indispensable in clinical trials, epidemiological studies, and reliability engineering. By estimating survival probabilities, researchers can evaluate treatment effectiveness,...
152
Methods of Documentation VI: Case Management Model
574
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic...
For example, a patient with a chronic...
574
Statistical Methods for Analyzing Epidemiological Data
372
Epidemiological data primarily involves information on specific populations' occurrence, distribution, and determinants of health and diseases. This data is crucial for understanding disease patterns and impacts, aiding public health decision-making and disease prevention strategies. The analysis of epidemiological data employs various statistical methods to interpret health-related data effectively. Here are some commonly used methods:
372
Actuarial Approach
79
The actuarial approach, a statistical method originally developed for life insurance risk assessment, is widely used to calculate survival rates in clinical and population studies. This method accounts for participants lost to follow-up or those who die from causes unrelated to the study, ensuring a more accurate representation of survival probabilities.
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
79


