The Research On Disability Weights Of Disease Burden

Objective:This study was aimed to develop an innovative approach to calculate the disability weights,with the characteristics of data accessible,operating easily and results reliable.Localized disability weights were achieved for multiple diseases and injuries,based on the sample data.Stability of the approach and the results were also verified.Key parameters were provided for the disease burden research in China and the new approach could make a reference for other countries and regions.Contents:The progress of the research was summarized both in disability weights assessment and diseases classification,which made the basis for the new method.The relationship was examined between medical expenditure and disability,and the new approach was developed to achieve disability weights based on inpatient expenditure comparison.The classification strategy of disability weights was put forward referring to diagnosis related group.Source from the first pages of medical records,the disability weights were measured as well as the stability of the results.Furthermore,the advantages and characteristics were discussed and suggestions for method application were put forward.Methods:Literature review was applied to summarize the progress of disability weights research and the theoretical basis of the new approach.Experts interview method was conducted to collect suggestions and opinions for developing new approach,and to confirm its feasibility and rationality.Comparative study was used to test the stability under the influence of time,regions and hospital levels,as well as the comparison with other research.The results were analyzed by descriptive statistical method and examined by correlation analysis.Results:Disability turned out to be an important factor of inpatient expenditure with a positive correlation.Thus,it was feasible to develop a new approach to calculate disability weights based on inpatient expenditure comparison.The new method was put forward as follows:the disability weight of a certain disease or injury was equal to its average inpatients expenditure divided by the value of the highest expenditure group.After adjustment of Beijing diagnosis related group,the suitable category strategy was determined for this research:according to the principal diagnosis and other diagnosis,cases were classified into major diagnostic categories and adjacent groups.Considering other factors of individuals' age,complications and comorbidities,groups were basically formed.Further frequency analysis was conducted in groups with complications and the highest frequency complication was selected out as a subdivision group added into the results.A total of 6 359 567 medical records were analyzed and the disability weights table was achieved with 25 major diagnostic categories and 564 groups,including 385 general groups and 179 subdivision groups.Disability weights showed a range of 0.020?0.995.Most of the disability weights were at a mild to moderate level,with a clearly skewed distribution.The first quartile P25,the median and the third quartile P75 were 0.113,0.178 and 0.278,respectively.Acute leukemia with complications and comorbidities was the most serious group.According to the tests,the new method was proved to be stable under the influence of time,regions and hospital levels.The overall distribution was consistent with the results of GBD2013.The tumor related disability weights in different research were not that comparable,while the tendency was almost similar.Discussions:An innovative approach was developed to calculate the disability weights of disease burden.It was proved that the results were reliable and stable,regardless of subjective factors in previous study.The number of disability weights was expanded quickly and easily,with the advantages of low cost and easy to apply.Moreover,referring to diagnosis related group,this study realized the disease classification and expenditure calculation in an almost complete disease spectrum and a large sample,which provided a new idea for classification of disability weights.This study has achieved the localized list of disability weights in our country for the first time.The results showed an obviously skewed distribution,indicating the health loss caused by most diseases and injuries was at a mild to moderate level.Key parameters were provided for the localized research of disease burden.Also,a powerful technical tool was developed,contributing to the fair and efficient health resources allocation,health economics evaluation and public policy analysis.The approach of calculating disability weights based on inpatient expenditure could be applied in many countries and regions,which made it possible to conduct localized disability weights and disease burden research,so as to serve the local public resources allocation and decision making.Suggestions:Based on the classification strategy,further refinement and update were expected to make the method more suitable for disability weights,and more scientific and accurate for classification and expenditure calculation.Continuous effort could be made to expand the number of disability weights.Meanwhile,more empirical research was suggested about the theoretical basis and application effect of the new approach,aimed to enrich the evidence and recommendation for the method application.It's suggested that further research could be conducted on localized disease burden and health economics evaluation in our country,based on the disability weights in this study.