| In recent years,with the rapid development of the social economy and the accelerating pace of life,great changes have taken place in people’s way of life and working environment.Many common diseases associated with aging have gradually begun to affect younger individuals,and the proportion of the population with suboptimal health has been increasing.It has become a norm,rather than an exception,for young people to suffer from a variety of diseases.Therefore,the mining of medical data of inpatients and the study of medical expenses are helpful to understand the disease status of inpatients,analyze multimoribidity patterns,and study the influencing factors of hospitalization costs.ObejctiveThe purpose of this study was to research and analyze the medical data of hospitalized patients,understand the disease status of inpatients,explore the core disease,analyze multimoribidity patterns,and study the influencing factors of hospitalization costs.It provides scientific basis for improving the system of disease screening,prevention and control,treatment and prognosis,making the medical care service more closely and more appropriately adapt to the needs of patients.Methods(1)Inpatient data for 397787 inpatients in 14 general hospitals in Jilin Province from January 1,2019,to December 31,2019,were selected.Frequency,rate or constituent ratio were used for descriptive analysis of qualitative data,and median and interquartile were used for quantitative variables that did not follow normal distribution.χ~2-test was used to compare qualitative data between groups,and Z-test and Kruskal-Wallis H test were used to compare quantitative variables that did not follow normal distribution between groups.(2)By using community network data mining methods and superimposing related factors(sex,age,hospital grade,health insurance schemes,etc.),the community classification of diseases and related factors as well as the associations between disease-disease and disease-related factors were determined,and they are presented in a visual form.(3)Association rule analysis was used to extract a large amount of valuable disease information from the medical data to determine the main multimorbidity patterns and the degree of association between major diseases.(4)The quantile regression method was used to analyze the main factors influencing hospitalization costs at different loci,providing a theoretical basis and data support for reasonable cost control measures.Results(1)The inpatients suffered mainly from diseases of the circulatory system,diseases of the digestive system and endocrine,nutritional and metabolic diseases.A total of 74.72%of inpatients suffered from multimorbidity.The proportion of multimorbidity in male inpatients was higher than that in female inpatients,the proportion of multimorbidity in high age group was higher than that in low age group,and the proportion of multimorbidity in urban residents was the highest.The hospitalization duration,total hospitalization cost,treatment cost,drug cost,diagnosis cost,inspection cost,laboratory cost,bed cost and nursing cost all increased with the number of diseases the patients suffered from,but which were not simply a stack of numbers.(2)Community multimorbidity network analysis found that hypertensive diseases(I1015),ischaemic heart diseases(I2025),other forms of heart disease(I3052)and cerebrovascular diseases(I6069)were common core diseases in the community multimorbidity network,and these four diseases were closely related and usually classified into the same community.In almost all multimorbidity networks,seven diseases of pregnancy,childbirth,and puerperium were usually grouped into the same community;the nine diseases of the eye and adnexa were usually grouped into the same community.(3)Association rule analysis identified three main multimorbidity patterns:The diseases of the circulatory system multimorbidity pattern was dominated by hypertensive diseases(I1015),ischaemic heart diseases(I2025)and other forms of heart disease(I3052).The diseases of the digestive system multimorbidity pattern was dominated by diseases of oesophagus,stomach and duodenum(K2031),noninfective enteritis and colitis(K5052)and other diseases of intestines(K5563).The pregnancy,childbirth and puerperium multimorbidity pattern was dominated by other maternal disorders predominantly related to pregnancy(O2029),maternal care related to the fetus and amniotic cavity and possible delivery problems(O3048)and complications of labour and delivery(O6075).(4)The results of the quantile regression analysis showed that male inpatients were positively associated with the total hospitalization cost and drug cost,and the influence coefficient increased with the increase in the hospitalization cost.In terms of age,the influence coefficient of the≥65 age group was the largest.The influence coefficient of tertiary hospitals was higher than that of secondary hospitals.Taking urban employee basic medical insurance as the reference,urban resident basic medical insurance had a negative impact on the total hospitalization cost,drug cost,examination cost and laboratory cost,but the new rural cooperative medical scheme had a positive impact on the total hospitalization cost,treatment cost,drug cost and laboratory cost.The length of stay and the number of diseases had a positive impact on the hospitalization cost.Conclusions(1)Diseases of the circulatory system,diseases of the digestive system and endocrine,nutritional and metabolic diseases are the main diseases leading to hospitalization.Therefore,effective measures should be taken to improve the prevention,control and treatment of these three diseases.(2)In terms of population,male inpatients,elderly inpatients and urban residents are more likely to have multimorbidity.In terms of diseases,hypertension,ischemic heart disease,other forms of heart disease and cerebrovascular diseases are common core diseases in the community multimorbidity weighted network network,and these kind diseases are easy to exist multi–disease coexistence phenomenon.Therefore,corresponding measures should be taken for key groups and diseases to effectively reduce the occurrence of multimorbidity.(3)The pattern of multimorbidity has become the norm rather than the exception.The most common multimorbidity in hospitalized patients were circulatory system diseases,digestive system diseases and pregnancy,childbirth and puerperium.Medical staff can use the multimorbidity pattern of this study as a reference when diagnosing patients.Necessary screening or examination should be carried out in advance for related diseases(especially the pre-condition diseases in the multimorbidity pattern)to improve the efficiency of disease diagnosis and treatment,thus reducing the burden on patients and the society.(4)The community weighted network of hospitalization and hospitalization costs reveals the association and community classification of disease-hospitalization days and disease-hospitalization costs in a simple,clear and straightforward visual form.The community weighted network can provide a reference for the development of multi-compound medical insurance payment mode based on DRG or DIP and related policies.(5)Multimorbidities have longer hospitalization time and higher cost than single diseases,especially for elderly male multimorbidities inpatients of the new rural cooperative medical scheme in tertiary hospitals.Therefore,the control of hospitalization costs should be combined with the multimorbidities of different populations and core diseases to take corresponding targeted measures. |
