Full
Outline
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.
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).
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%.
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.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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