Study On Grouping Model Of TCM Disease And Dyndrome Diagnosis Based On The First Page Of Medical Records

Objective According to the CHS-DRG grouping scheme,the first page data of inpatient medical records of some Traditional Chinese medicine hospitals above county level in a province were used for grouping study,and the grouping model of disease and syndrome diagnosis of TCM hospitals was designed.From the strengths,weaknesses,threats and opportunities to explore the necessity of DRGs,hospital of traditional Chinese medicine research analysis directly the CHS-DRG grouping scheme for the applicability of the Chinese medicine hospital cases,combined with the actual situation and theory foundation scheme grouping model with elements of traditional Chinese medicine,to make with characteristic of TCM hospital of traditional Chinese medicine to provide ideas for ways to pay,Promote the standardization,informatization and fine management of medical service of the first page of medical records in TCM hospitals.Methods In this study,literature analysis was used to sort out the related studies on disease diagnosis-related grouping and TCM DRGs in recent years,and the research status and experience were summarized to provide reference for this study.In the design of the grouping model of disease and syndrome diagnosis,the expert consultation method was used to consult the TCM elements that should be included in the grouping model of relevant experts in the industry,collect and sort out the opinions of experts put forward in the study of the grouping model,and preliminarily design three grouping models of disease and syndrome diagnosis.The first page data of inpatients’ medical records in some TCM hospitals above the county level in a province from January 1,2018 to December 31,2020 were collected.General descriptive statistics were used for preliminary analysis of the first page data of medical records.Then,based on the CHS-DRG grouping scheme and the three models designed in this study,Self-programmed,two-step clustering method was used to group the first page data of medical records and evaluate the grouping results.Finally,k-prototypes clustering was used to verify the grouping models.Results In this study,a total of 179,804 eligible cases were screened out from the first page of inpatient records reported by public TCM hospitals in the province according to the index data requirements of this study.Among the cases,the mean age of patients was 53.13 years old,and there were 91224 male patients,accounting for 50.74% of the total number of patients,and88,557 female patients,accounting for 49.25% of the total number of patients.In terms of length of stay and cost of stay,the median length of stay was 8days;The median hospitalization cost was 5024.41 yuan;The patients were mainly transferred to hospital after outpatient treatment,accounting for 87.8%;The second was emergency admission,accounting for 8.9%;Basic medical insurance for urban residents accounts for 40.1 percent of all medical payments.In 179804 cases,the main treatment was the combination of Traditional Chinese and western medicine,accounting for 68.5%;The second was western medicine treatment,accounting for 24.2%;TCM treatments ranked last,accounting for 7.3%.According to the CHS-DRG grouping scheme,the screened cases were grouped into 368 DRGs,and 131 DRGs met the criteria for the number of cases in the CHS-DRG scheme.Among 131 DRGs,95 DRGs had CV less than 1,and 36 DRGs had CV greater than 1.For the disease group with more than 100 cases and CV more than 1,three grouping schemes and methods with the elements of TCM were designed,and TCM characteristic elements such as TCM disease name diagnosis and TCM syndrome diagnosis were included for further subgrouping.After grouping,statistical methods were used to test and compare the effects of each grouping.The grouping effect of the diagnosis related grouping model included in TCM disease name diagnosis was the best,the coefficient of variation CV of each DRGs group decreased,and the RIV between groups was large.However,the grouping effect of the three diagnostic related grouping models did not reach the grouping standard.Conclusions At present,there is controversy about whether DRGs is applicable to TCM,but this study found through SWOT analysis that it is necessary to study the grouping model related to TCM disease and syndrome diagnosis.The first page data of inpatient medical records in a provincial traditional Chinese medicine hospital was used to replicate the CHS-DRG grouping model,and it was found that the case grouping results were poor,and the CV of the disease group was greater than 1.Therefore,the applicability of CHS-DRG grouping scheme for inpatient cases in traditional Chinese medicine hospitals needs to be improved,and the CHS-DRG grouping scheme lacked traditional Chinese medicine characteristics and had poor grouping effect.According to CHS-DRG,three grouping models with TCM elements were designed,and case grouping was performed according to the three models.The grouping effect was improved,but the three grouping models still failed to meet the standards.The data results of this study indicated that DRGs based on western medicine diagnosis and treatment pathway was not suitable for TCM hospitals.In the later stage,we should follow the development law of TCM itself and the basic theory of TCM,construct a brand new grouping model of TCM characteristics,and formulate the grouping standard and technical scheme of TCM diseases.In the process of sorting out the first page of TCM inpatient medical records,it was found that the first page of TCM inpatient medical records had data missing,diagnostic coding error or non-standard filling,which was not conducive to the study of TCM case grouping model.Therefore,TCM hospitals should focus on the optimization and improvement of hospital management informatization,quality control of the first page of medical records and writing of diagnosis code,so as to provide basic conditions for the study of TCM diagnostic related grouping model.