A decision tree-based study of pulmonary tuberculosis diagnosis-related groups

Article type: Research Article

Authors: Liu, Lei^{a; 1} | Guo, Jing^{b; 1} | Ding, Kun^a | Zhou, Guang-Nao^b | Feng, Yin-Ping^b | Zhang, Na-Na^{c; *}

Affiliations: [a] Department of Quality Management, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China | [b] Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China | [c] Department of Pharmacy, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China

Correspondence: [*] Corresponding author: Na-Na Zhang, Department of Pharmacy, Lishui Hospital of Traditional Chinese Medicine, No. 800 Zhong Shan Road, Lian Du District Lishui, Zhejiang 323000, China. Tel.: +86 18857819759; E-mail: nanazhangznn@126.com.

Note: [1] These authors contributed equally to this study.

Abstract: BACKGROUND: Globally, pulmonary tuberculosis is a significant public health and social problem. OBJECTIVE: We investigated the factors influencing the hospitalization cost of patients with pulmonary tuberculosis and grouped cases based on a decision tree model to provide a reference for enhancing the management of diagnosis-related groups (DRGs) of this disease. METHODS: The data on the first page of the medical records of patients with the primary diagnosis of pulmonary tuberculosis were extracted from the designated tuberculosis hospital. The influencing factors of hospitalization cost were determined using the Wilcoxon rank sum test and multiple linear stepwise regression analysis, and the included cases were grouped using the chi-squared automated interaction test decision tree model, with these influential factors used as classification nodes. In addition, the included cases were grouped according to the ZJ-DRG grouping scheme piloted in Zhejiang Province, and the differences between the two grouping methods were compared. RESULTS: The length of hospital stay, respiratory failure, sex, and age were the determining factors of the hospitalization cost of patients with pulmonary tuberculosis, and these factors were incorporated into the decision tree model to form eight case combinations. The reduction in variance (RIV) using this grouping method was 60.60%, the heterogeneity between groups was high, the coefficients of variance ranged from 0.29 to 0.47, and the intra-group difference was small. The patients were also divided into four groups based on the ZJ-DRG grouping scheme piloted in Zhejiang Province. The RIV using this grouping method was 55.24, the differences between groups were acceptable, the coefficients of variance were 1.00, 0.61, 0.77, and 0.87, respectively, and the intra-group difference was significant. CONCLUSION: When the pulmonary tuberculosis cases were grouped according to the duration of hospital stay, respiratory failure, and age, the results were rather reasonable, providing a reference for DRG management and cost control of this disease.

Keywords: Decision tree model, disease-related diagnostic grouping, hospitalization costs, influencing factors, pulmonary, tuberculosis

DOI: 10.3233/THC-231827

Journal: Technology and Health Care, vol. 32, no. 5, pp. 3139-3152, 2024