Study On The Structure Of Traumatic Diseases,Influencing Factors Of Hospitalization Costs And Their Prediction In A Hospital In Dali

ObjectiveThe quality of major trauma diagnosis codes was analyzed,the composition and cost of hospital trauma were studied,and the epidemiological characteristics and disease composition of trauma were identified to provide data support for the formulation of prevention and treatment strategies and measures for trauma.MethodsThe first page information of medical records of trauma inpatients from a Grade-Ⅲ hospital in Yunnan Province from 2018 to 2021 was extracted.After correcting the main diagnosis of medical records according to the diagnostic coding rules,the types of coding errors were summarized and 13306 medical records meeting the requirements were finally obtained.Grey correlation analysis and structural variation degree analysis were used to study the internal composition and variation trend of hospital expenses for trauma patients from 2018 to 2021.Chi-square test and binary Logistic regression analysis were used to screen the influencing factors of trauma hospitalization costs.Variables with P<0.05 were included in the decision tree,random forest and support vector machine models to fit the prediction model,and the prediction effect of the three models was compared.Results1.There were 825 cases with errors in the main diagnosis,among which 394 cases had errors in the main diagnosis that were not specific.This was followed by the failure to encode S and T codes for trauma caused by external causes(177 cases),failure to select the highest severity of trauma as the primary diagnosis(105 cases),miscoding S and T codes for non-traumatic diseases(84 cases),and miscoding the primary diagnosis as the initial trauma code(9 cases).2.From 2018 to 2021,the number of trauma patients in the hospital showed a fluctuating increase trend,with a male to female ratio of about 2:1 and a median age of 45.The main trauma type of the inpatients was fracture,accounting for 54.32% of all cases;the trauma site concentrated on the head and neck,accounting for 26.02% of all cases;the main external cause of trauma was fall,accounting for 54.29% of all patients.3.The average annual growth rate of trauma hospitalization cost was -3.02%,and the strongest correlation with hospitalization cost was consumables cost(1.00),followed by medicine cost(0.87),with the highest variation contribution rate of 31.98% and 28.34%,respectively.4.Chi-square test results showed that 15 factors,including gender,age,nationality,occupation,admission route,transfer condition,injury degree,trauma site,whether there are complications or complications,trauma cause,whether to perform tertiary and tertiary operations,whether to use ventilator,length of stay,proportion of consumables and proportion of drug expenses,all had significant effects on hospitalization costs(P<0.01).A binary logistic regression model was constructed with 15 factors P<0.01 in the Chi-square test results as independent variables,and whether or not high hospitalization cost was the dependent variable.The results showed that 13 variables,including age,admission route,transfer condition,injury degree,trauma site,whether there were complications or complications,external causes of trauma,whether to perform tertiary or tertiary operations,whether to use ventilators,way of discharge,length of stay,proportion of consumables and proportion of drug expenses,were influencing factors of hospitalization costs(P<0.001).5.The 11 variables excluding the proportion of consumables and the proportion of drug costs were included into the prediction model of decision tree,random forest and support vector machine,and the best prediction model was random forest model.Conclusions1.The types of errors in the main diagnosis coding of trauma include that the anatomical site or the degree of trauma was not specific,the trauma caused by external causes was not coded with S and T codes,the highest severity of trauma was not selected as the main diagnosis,non-traumatic diseases were miscoded with S and T codes,the main diagnosis was inconsistent with the main surgery,and the main diagnosis of trauma complications,sequelae and traumatic severing was miscoded with the initial trauma code.2.Among the internal components of trauma hospitalization costs,consumables cost had the highest correlation with hospitalization costs,which was the most important part affecting the change of hospitalization costs.3.The top five factors that have the greatest influence on the cost of trauma hospitalization were the number of days in hospital,whether three or four stage of surgery was performed,the site of trauma,the degree of injury and the age.4.The stochastic forest model had a good prediction effect on the hospitalization costs of trauma.This method could avoid data overfitting and was more conducive to our prediction of hospitalization costs based on the basic information and treatment plan of trauma patients.5.The accuracy of medical record coding quality should be improved by strengthening the communication between doctors and coders,so as to ensure the accuracy of medical big data.