Article(id=1324077812994421078, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509003, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1756656000000, receivedDateStr=2025-09-01, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614350793, onlineDateStr=2026-11-02, pubDate=1773072000000, pubDateStr=2026-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614350793, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614350793, creator=13701087609, updateTime=1793614350793, updator=13701087609, issue=Issue{id=1324077716676424398, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='1773072000000', pubDateStr='2026-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614327830, creator='13701087609', updateTime=1793614418028, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078095132655884, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078095132655885, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=878, endPage=884, ext={EN=ArticleExt(id=1324077814810554713, articleId=1324077812994421078, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=DRGs grouping model of traditional Chinese medicine diseases and syndromes for dominant diseases in traditional Chinese medicine: a study of hemorrhoids, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective To explore the diagnosis related group(DRG) grouping model of traditional Chinese medicine diseases and syndromes under the mode of traditional Chinese medicine disease and syndrome and Western medicine diagnosis, and provide references for relevant medical insurance departments to improve DRG of Zhejiang Province(ZJ-DRG) scheme and enhance its applicability in traditional Chinese medical institutions.
Methods Discharged patients, from 2020 to 2023, in a tertiary TCM hospital of Zhejiang were selected, and their medical record homepage and the DRG grouping data were collected. Hemorrhoids(ICD-10 code: I84.0-I84.9) were selected as the target disease type for dominant diseases in traditional Chinese medicine. A multilayer perceptron (MLP) neural network and K-prototypes clustering algorithm were used to screen categorical node variables, and decision tree model was used to group hemorrhoids inpatients. The between-group heterogeneity and within-group homogeneity of the established model were evaluated through the coefficient of variation (CV) and the reduction in variance (RIV).
Results The 4 663 hemorrhoids inpatients in this study were divided into 6 DRGs according to the ZJ-DRG scheme, and the heterogeneity between these groups (RIV: 1.92%) and the homogeneity within these groups (CV: 9.34%-26.29%) were moderate. Through the K-P clustering algorithm based on “Primary diagnosis-Primary symptom-Main Surgery or procedure”, 10 DRGs were formed, with the RIV increasing to 9.05% and the CV ranging between 17.14% and 22.99%. By further integrating traditional Chinese medicine specific indicators and complications, under the decision tree model (CRT algorithm), the RIV increased to 34.59%.
Conclusion The constructed DRGs grouping model of traditional Chinese medicine diseases and syndromes has improved grouping efficiency and enhanced the heterogeneity between these groups. It can provide a reference for establishing a hierarchical and segmented disease group incentive mechanism for target dominant diseases in traditional Chinese Medicine.
, authors=Ling-ling PANG
1, Ge ZHOU
1, Jun-ming XIE
2, Zhen-zhen SHAO
3, Hua-qin SUN
2, Ke DING
2, Li WU
4, authorsList=Ling-ling PANG, Ge ZHOU, Jun-ming XIE, Zhen-zhen SHAO, Hua-qin SUN, Ke DING, Li WU, authorCompany=null, correspAuthors=Ge ZHOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077816198869346, articleId=1324077812994421078, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中医优势病种的中医病证DRGs分组模型研究——以痔病为例, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的 探究“中医病证+西医诊断”模式下的中医病证诊断相关分组（diagnosis related groups,DRGs）分组模型，为相关部门优化浙江省疾病诊断相关分组（diagnosis related group of zhejiang, ZJ-DRG）方案，提高其在中医医疗机构适用性提供参考。
方法 收集2020—2023年浙江省某综合性三甲中医医院出院患者的病案首页数据和DRG分组数据，选取痔病（ICD-10编码：I84.0 ～I84.9）为目标中医药治疗优势病种。采用多层感知机（multilayer perceptron, MLP）神经网络模型和K-Prototypes聚类算法筛选分类节点，并利用决策树模型进行痔病病例分组，通过变异系数（coefficient of variation, CV）和方差减少量（reduction in variance, RIV）对所建立模型进行组内同质性和组间异质性评价。
结果 本研究纳入的4 663名痔病患者按ZJ-DRG 分组，研究对象被分为6个DRGs 组，组间异质性（RIV：1.92%）和组内同质性（CV：9.34%～26.29%）均一般。在基于“主诊断_主证_主要手术操作”的 K-P聚类算法分组下，共形成10个DRGs 组，RIV值提升至9.05%，CV值在17.14%～22.99%间不等。进一步融合中医特色指标及并发症，决策树模型（CRT 算法）下，RIV 提升至34.59%。
结论 所构建的中医病证DRGs分组模型改善了分组效能，增强组间异质性，可为建立中医优势病种的分层、分区段病组激励机制提供参考。
, authors=庞玲玲
1, 周歌
1, 谢俊明
2, 邵珍珍
3, 孙华琴
2, 丁科
2, 吴丽
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庞玲玲（1994—），女，硕士，住院医师，研究方向：医疗保障、DRG 政策
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本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=0ygr8nICYhiqADRNN78xWg==, magXml=21C2G0mbooOocAWVjP6hgQ==, pdfUrl=null, pdf=UDiOe0N9MT0CWjF5O5ugUQ==, pdfFileSize=1032607, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=d9wYTCar1NY1QRpa799BrA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=WhNPUhMzqcc5gKu/8lLLZw==, mapNumber=null, fund=null)}, authors=[Author(id=1324077816819626349, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1324077816903512431, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, authorId=1324077816819626349, language=EN, stringName=Ling-ling PANG, firstName=Ling-ling, middleName=null, lastName=PANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=
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Decision tree model for case-mix of hemorrhoids, figureFileSmall=rIhpTLYy7PYLf1Hgdke50g==, figureFileBig=d9wYTCar1NY1QRpa799BrA==, tableContent=null), ArticleFig(id=1324077821076844954, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, language=CN, label=图1, caption=
痔病病例组合的决策树模型, figureFileSmall=rIhpTLYy7PYLf1Hgdke50g==, figureFileBig=d9wYTCar1NY1QRpa799BrA==, tableContent=null), ArticleFig(id=1324077821294948763, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, language=EN, label=Table 1, caption=
Grouping effect of ZJ-DRG grouper in hemorrhoid patients admitted to traditional Chinese medicine hospitals ［n（%），M（P25，P75）］
, figureFileSmall=null, figureFileBig=null, tableContent=
| 分组编码 | 分组名称 | 中医组 | 西医组 | 合计 |
|---|
| 例数 | 住院总费用(元) | CV#(%) | 例数 | 住院总费用(元) | CV#(%) | 例数 | 住院总费用(元) | CV#(%) |
|---|
| GF11 | 肛管、肛门及肛周手术，伴严重并发症与合并症 | 47
(1.3) | 10 102.44
(6 835.84, 12 644.08) | 26.73 | 9
(0.8) | 12 126.35
(11 317.6, 14 473.32) | 22.12 | 56
(1.2) | 11 055.04
(7 297.60, 12 809.25) | 26.29 |
| GF13 | 肛管、肛门及肛周手术，伴一般并发症与合并症 | 1 716
(48.5) | 8 822.25
(7 558.98, 10 370.7) | 20.91 | 338
(30) | 8 679.67
(7 054.18, 10 405.71) | 22.50 | 2 054
(44) | 8 812.74
(7 449.45, 10 372.55) | 21.16 |
| GF15 | 肛管、肛门及肛周手术，不伴并发症与合并症 | 1 681
(47.5) | 8 385.98
(7 167.04, 9 610.58) | 19.68 | 597
(53) | 8 249.14
(6 422.68, 9 538.67) | 19.87 | 2 278
(48.9) | 8 348.82
(6 969.45, 9 593.49) | 19.73 |
| GZ11 | 其他消化系统诊断，伴严重并发症与合并症 | 3
(0.1) | — | — | 3
(0.3) | — | 12.60 | 6
(0.1) | 5 276.81
(3 159.75, 7 701.08) | 9.34 |
| GZ13 | 其他消化系统诊断，伴一般并发症与合并症 | 37
(1.0) | 2 934.24
(1 778.00, 4 497.79) | 21.27 | 57
(5.1) | 3 053.61
(1 915.32, 4 740.68) | 15.37 | 94
(2.0) | 3 038.75
(1 785.42, 4 689.66) | 18.20 |
| GZ15 | 其他消化系统诊断，不伴并发症与合并症 | 52
(1.5) | 2 336.16
(1 108.02, 3 365.90) | 19.24 | 123
(10.9) | 2 655.32
(888.27, 3 232.12) | 8.27 | 175
(3.8) | 2 570.01
(899.28, 3 252.74) | 24.84 |
), ArticleFig(id=1324077821416583580, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, language=CN, label=表1, caption=
ZJ-DRG分组器在中医医院收治痔病中的分组效果［n（%），M（P25，P75）］
, figureFileSmall=null, figureFileBig=null, tableContent=
| 分组编码 | 分组名称 | 中医组 | 西医组 | 合计 |
|---|
| 例数 | 住院总费用(元) | CV#(%) | 例数 | 住院总费用(元) | CV#(%) | 例数 | 住院总费用(元) | CV#(%) |
|---|
| GF11 | 肛管、肛门及肛周手术，伴严重并发症与合并症 | 47
(1.3) | 10 102.44
(6 835.84, 12 644.08) | 26.73 | 9
(0.8) | 12 126.35
(11 317.6, 14 473.32) | 22.12 | 56
(1.2) | 11 055.04
(7 297.60, 12 809.25) | 26.29 |
| GF13 | 肛管、肛门及肛周手术，伴一般并发症与合并症 | 1 716
(48.5) | 8 822.25
(7 558.98, 10 370.7) | 20.91 | 338
(30) | 8 679.67
(7 054.18, 10 405.71) | 22.50 | 2 054
(44) | 8 812.74
(7 449.45, 10 372.55) | 21.16 |
| GF15 | 肛管、肛门及肛周手术，不伴并发症与合并症 | 1 681
(47.5) | 8 385.98
(7 167.04, 9 610.58) | 19.68 | 597
(53) | 8 249.14
(6 422.68, 9 538.67) | 19.87 | 2 278
(48.9) | 8 348.82
(6 969.45, 9 593.49) | 19.73 |
| GZ11 | 其他消化系统诊断，伴严重并发症与合并症 | 3
(0.1) | — | — | 3
(0.3) | — | 12.60 | 6
(0.1) | 5 276.81
(3 159.75, 7 701.08) | 9.34 |
| GZ13 | 其他消化系统诊断，伴一般并发症与合并症 | 37
(1.0) | 2 934.24
(1 778.00, 4 497.79) | 21.27 | 57
(5.1) | 3 053.61
(1 915.32, 4 740.68) | 15.37 | 94
(2.0) | 3 038.75
(1 785.42, 4 689.66) | 18.20 |
| GZ15 | 其他消化系统诊断，不伴并发症与合并症 | 52
(1.5) | 2 336.16
(1 108.02, 3 365.90) | 19.24 | 123
(10.9) | 2 655.32
(888.27, 3 232.12) | 8.27 | 175
(3.8) | 2 570.01
(899.28, 3 252.74) | 24.84 |
), ArticleFig(id=1324077821617910173, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, language=EN, label=Table 2, caption=
Evaluation of K-P clustering algorithm grouping for hemorrhoids based on “Primary diagnosis-Primary symptom-Main Surgery or procedure”
, figureFileSmall=null, figureFileBig=null, tableContent=
| 分组 | 例数 | 住院总费用 | CV# | RIV# |
|---|
 | s | M |
|---|
| 0 | 335 | 5 189.28 | 3 715.37 | 4 401.37 | 19.19 | 9.05 |
| 1 | 631 | 9 956.71 | 2 070.96 | 9 509.30 | 17.14 |
| 2 | 184 | 8 793.37 | 2 920.09 | 8 881.16 | 20.74 |
| 3 | 727 | 8 275.82 | 10 529.93 | 8 093.58 | 22.93 |
| 4 | 724 | 8 987.26 | 1 803.24 | 8 767.54 | 17.44 |
| 5 | 263 | 10 057.12 | 2 873.97 | 10 195.75 | 20.73 |
| 6 | 511 | 8 098.51 | 2 828.89 | 7 936.07 | 22.43 |
| 7 | 115 | 7 637.18 | 2 659.07 | 7 333.83 | 22.99 |
| 8 | 1 139 | 7 517.40 | 2 651.08 | 7 823.07 | 19.50 |
| 9 | 34 | 7 523.12 | 2 280.32 | 7 618.96 | 17.45 |
), ArticleFig(id=1324077821768905118, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, language=CN, label=表2, caption=
痔病“主诊断_主证_手术操作”K-P聚类算法分组评价
, figureFileSmall=null, figureFileBig=null, tableContent=
| 分组 | 例数 | 住院总费用 | CV# | RIV# |
|---|
| | s | M |
|---|
| 0 | 335 | 5 189.28 | 3 715.37 | 4 401.37 | 19.19 | 9.05 |
| 1 | 631 | 9 956.71 | 2 070.96 | 9 509.30 | 17.14 |
| 2 | 184 | 8 793.37 | 2 920.09 | 8 881.16 | 20.74 |
| 3 | 727 | 8 275.82 | 10 529.93 | 8 093.58 | 22.93 |
| 4 | 724 | 8 987.26 | 1 803.24 | 8 767.54 | 17.44 |
| 5 | 263 | 10 057.12 | 2 873.97 | 10 195.75 | 20.73 |
| 6 | 511 | 8 098.51 | 2 828.89 | 7 936.07 | 22.43 |
| 7 | 115 | 7 637.18 | 2 659.07 | 7 333.83 | 22.99 |
| 8 | 1 139 | 7 517.40 | 2 651.08 | 7 823.07 | 19.50 |
| 9 | 34 | 7 523.12 | 2 280.32 | 7 618.96 | 17.45 |
), ArticleFig(id=1324077821836013983, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, language=EN, label=Table 3, caption=
Case-mix grouping results of hemorrhoids (DRG)
, figureFileSmall=null, figureFileBig=null, tableContent=
| 分组编码 | K-P分组 | 住院天数分组 | 治疗方式 | 中治率 | 并发症 | 例数(%) | 住院总费用(元) | CV#(%) |
|---|
 | s | M |
|---|
| DRG1 | 0.0;4.0;8.0;7.0;9.0 | 4d | — | — | — | 524
(11.24) | 8 460.56 | 1 514.48 | 8 429.8 | 15.17 |
| DRG2 | 3.1;1.0;2.0;6.0;5.0 | 4d | — | ≤12.37 | — | 451
(9.67) | 9 763.93 | 1 693.84 | 9 553.71 | 15.75 |
| DRG3 | 3.1;1.0;2.0;6.0;5.0 | 4d | — | >12.37 | — | 93
(1.99) | 8 654.3 | 1 597.65 | 8 908.71 | 15.08 |
| DRG4 | 1.0 | ≤3d | 西医手术;中医肛肠技术;中医肛肠技术+西医手术 | — | — | 222(4.76) | 8 923.93 | 1 238.39 | 8 925.135 | 13.88 |
| DRG5 | 4.0 | ≤3d | 西医手术;中医肛肠技术;中医肛肠技术+西医手术 | — | — | 238(5.1) | 7 766.24 | 1 238.94 | 7 793.66 | 13.68 |
| DRG6 | 0.0;3.0;2.0;8.0;7.0;6.0;5.0;9.0 | ≤3d | 西医手术;中医肛肠技术 | — | — | 695
(14.9) | 5 336.22 | 2 185.26 | 5 371.29 | 16.90 |
| DRG7 | 0.0;3.0;2.0;8.0;7.0;6.0;5.0;9.0 | ≤3d | 中医肛肠技术+西医手术 | — | — | 969
(20.78) | 7 093.48 | 2 199.17 | 7 493.07 | 17.32 |
| DRG8 | — | ≤3d | 保守治疗 | — | 无 | 77
(1.65) | 1 340.42 | 1 279.17 | 899.28 | — |
| DRG9 | — | ≤3d | 保守治疗 | — | 一般;严重 | 56
(1.2) | 2 805.23 | 1 812.27 | 2 650.85 | 11.56 |
| DRG10 | — | ≥5d | — | — | — | 1338
(28.69) | 10 708.79 | 7 751.36 | 10 129.52 | 17.83 |
), ArticleFig(id=1324077821919900064, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077812994421078, language=CN, label=表3, caption=
痔病的病例组合分组情况(DRG)
, figureFileSmall=null, figureFileBig=null, tableContent=
| 分组编码 | K-P分组 | 住院天数分组 | 治疗方式 | 中治率 | 并发症 | 例数(%) | 住院总费用(元) | CV#(%) |
|---|
| | s | M |
|---|
| DRG1 | 0.0;4.0;8.0;7.0;9.0 | 4d | — | — | — | 524
(11.24) | 8 460.56 | 1 514.48 | 8 429.8 | 15.17 |
| DRG2 | 3.1;1.0;2.0;6.0;5.0 | 4d | — | ≤12.37 | — | 451
(9.67) | 9 763.93 | 1 693.84 | 9 553.71 | 15.75 |
| DRG3 | 3.1;1.0;2.0;6.0;5.0 | 4d | — | >12.37 | — | 93
(1.99) | 8 654.3 | 1 597.65 | 8 908.71 | 15.08 |
| DRG4 | 1.0 | ≤3d | 西医手术;中医肛肠技术;中医肛肠技术+西医手术 | — | — | 222(4.76) | 8 923.93 | 1 238.39 | 8 925.135 | 13.88 |
| DRG5 | 4.0 | ≤3d | 西医手术;中医肛肠技术;中医肛肠技术+西医手术 | — | — | 238(5.1) | 7 766.24 | 1 238.94 | 7 793.66 | 13.68 |
| DRG6 | 0.0;3.0;2.0;8.0;7.0;6.0;5.0;9.0 | ≤3d | 西医手术;中医肛肠技术 | — | — | 695
(14.9) | 5 336.22 | 2 185.26 | 5 371.29 | 16.90 |
| DRG7 | 0.0;3.0;2.0;8.0;7.0;6.0;5.0;9.0 | ≤3d | 中医肛肠技术+西医手术 | — | — | 969
(20.78) | 7 093.48 | 2 199.17 | 7 493.07 | 17.32 |
| DRG8 | — | ≤3d | 保守治疗 | — | 无 | 77
(1.65) | 1 340.42 | 1 279.17 | 899.28 | — |
| DRG9 | — | ≤3d | 保守治疗 | — | 一般;严重 | 56
(1.2) | 2 805.23 | 1 812.27 | 2 650.85 | 11.56 |
| DRG10 | — | ≥5d | — | — | — | 1338
(28.69) | 10 708.79 | 7 751.36 | 10 129.52 | 17.83 |
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