CN109523406A - A kind of disease score value calculation method and calculating equipment based on data analysis - Google Patents
A kind of disease score value calculation method and calculating equipment based on data analysis Download PDFInfo
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Abstract
The embodiment of the invention discloses a kind of disease score value calculation method based on data analysis and calculate equipment, this method comprises: calculating equipment passes through the case data of the first case of reception, the affiliated disease classification corresponding disease basis score value of the first case is searched in disease score value dictionary table, disease score value dictionary table includes the corresponding relationship of disease classification with basic disease score value, in turn, according to the case load of first case it is judged that whether insured people is children in first case, if so, determining the corresponding adjusting parameter of first case；In turn, the disease score value of first case is calculated according to the first foundation disease score value and the adjusting parameter, realize the further adjustment for paediatrics occurring the disease score value of case, disease score value charge method is further optimized for the actual conditions of case, meet requirement of the complicated case data to disease score value, so that the medical payment mode of DRGs-based payment system can effectively be implemented.
Description
Technical field
The present invention relates to medical insurance technical field more particularly to a kind of disease score value calculation methods based on data analysis
And calculate equipment.
Background technique
With the layout of national public medical and deepening continuously for medical reform, reform of payment system is that system engineering is doctor
It protects management philosophy and the embodiment of great change occurs for medical insurance handling institution role.Implementation is paid according to disease, has fully demonstrated branch
The system of paying is only the key point of comprehensive medical reform.
So-called DRGs-based payment system just refers to through unified medical diagnosis on disease classification, scientifically makes each disease
Quota reimbursemen standard, social security mechanism according to the standard be hospitalized person-time, to designated medical organization pay hospitalization cost so that medical
Quantity, disease complexity and the service of resource usage criteria, i.e. medical institutions' resource consumption and the inpatient treated
Intensity is directly proportional.It is simply that clear stipulaties a certain kind disease flower how much, to both avoid medical institutions' abuse
Medical service item, duplicated project and decomposition project, prevent hospital from asking for great treatment only minor illness, in turn ensure medical service quality.
The means of payment that standardized medical information is applied to according to charges disease for medical information big data is extremely important,
The standardization of medical information is the premise realizing medical big data and being applied.The classification of disease generallys use international disease at present
Classify (international Classification of diseases, ICD).ICD-10 according to the cause of disease, position, pathology and
Disease is divided into 21 chapters and sections, more than 26000 kinds of diseases by the features such as clinical manifestation, and is encoded to each disease.However, for
For the integrated environment of the medical treatment of China, the common disease in each area is far less than 26000, and healthcare givers is in record case
When, due to the diversity of disease, complexity in the prior art, medical worker does not often carry out grade according to international standard, each
There is the language description of regionalization in area, carrys out certain difficulty to the out tape of DRGs-based payment system.
According to the rules, when various regions determine DRGs-based payment system payment standards, medical service cost, previously reality should be fully considered
The factors such as generation expense, medical insurance fund ability to bear and insured people's burden level are led in conjunction with disease primary operational and therapeutic modality
It crosses and negotiates negotiation with medical institutions and rationally determine how according to the medical conditions of various regions to determine payment standards, how to manage by disease
The medical expense of kind payment, testing and analyzing case, medical standardized payment etc. is all current technical problem urgently to be solved.
Summary of the invention
It is set the technical problem to be solved by the embodiment of the invention is that providing a kind of disease score value calculation method and calculating
It is standby, whether it is children by insured people in identification case, realizes the further adjustment for paediatrics occurring the disease score value of case, make
Obtaining disease score value charge method can further be optimized for the actual conditions of case, meet complicated case data pair
The requirement of disease score value.
In a first aspect, the embodiment of the invention provides a kind of disease score value calculation methods, this method comprises:
Calculate the case data that equipment receives the first case；
The calculating equipment searches the affiliated disease classification corresponding first of first case in disease score value dictionary table
Basic disease score value, the disease score value dictionary table include the corresponding relationship of disease classification with basic disease score value；
It is described calculate equipment according to the case load of first case it is judged that in first case insured people whether be
Children, if so, determining the corresponding adjusting parameter of first case, the adjusting parameter is used for the disease to first case
Kind score value is adjusted；
The calculating equipment calculates first case according to the first foundation disease score value and the adjusting parameter
Disease score value, the disease score value of first case are used to calculate the prediction medical insurance of first case.
In one possible implementation, the disease is classified as the item in disease classifying dictionary, the disease classification
Dictionary includes the classification of M disease and classifies code with the M disease one-to-one M disease of classifying, and the disease is classified
Code is the top N code of ICD coding or ICD coding, and the N is the positive integer less than 6, and M is positive integer.
In another possible implementation, the calculating equipment is according to the case load of first case it is judged that institute
It states whether insured people in the first case is children, specifically includes:
The calculating equipment judges whether the age of insured people in first case is less than preset value, first case
Generation department whether be paediatrics department, first case generation hospital whether be paediatrics section hospital, it is described first disease
Whether the dosage of the first drug is in the Xiang Douwei of the calculating equipment judgement less than one or more in the first dosage in example
When, insured artificial children in first case.
In another possible implementation, the corresponding adjusting parameter of the determination paediatrics includes:
The calculating equipment according to adjusting parameter table search first case belonging to disease classification it is corresponding first adjust
Whole parameter, the adjusting parameter table include the classification of N number of disease and classify one-to-one adjusting parameter with N number of disease, and N is
Positive integer, N are not more than M.
Optionally, before the corresponding adjusting parameter of the determination paediatrics, the method also includes: generate the adjustment
Parameter list, wherein the first disease is classified as any one disease classification in N number of disease classification, described to generate the tune
Whole parameter list includes:
Case collection is received, the case collection includes multiple cases, insured people in any one case in the multiple case
It is the first disease type and including practical medical insurance for children, disease type；
The practical medical insurance of each case is concentrated to calculate the average doctor of the case concentration case according to the case
Premium is used；
The average medical insurance of case is concentrated to calculate the paediatrics basis disease of the first disease type according to the case
Score value, and the corresponding second basic disease score value of the first disease classification is searched in disease score value dictionary table；
The first disease classification pair is calculated according to the paediatrics basis disease score value and the second basic disease score value
The adjusting parameter answered.
In another possible implementation, it is described according to the paediatrics basis disease score value and it is described second basis disease
Kind score value calculates the corresponding adjusting parameter of the first disease classification
σ1=(A '1-A1)/A1；
Wherein, σ1For the corresponding adjusting parameter of first disease classification, A '1For the paediatrics basis disease score value, A1For
Described second basic disease score value.
In another possible implementation, the calculating equipment is according to the first foundation disease score value and the tune
The disease score value that whole parameter calculates first case includes:
Y=A* σ * C
Wherein, Y is the disease score value of first case, and A is the first foundation disease score value, and σ is first disease
The adjusting parameter of example, C are the hospital grade coefficient of hospital where first case.
Second aspect, the embodiment of the present application also provides a kind of calculating equipment, the calculating equipment includes:
Receiving unit, for receiving the case data of the first case；
Searching unit, for searching the affiliated disease classification corresponding first of first case in disease score value dictionary table
Basic disease score value, the disease score value dictionary table include the corresponding relationship of disease classification with basic disease score value；
Judging unit, for according to the case load of first case it is judged that in first case insured people whether be
Children；
Determination unit is when being, to determine the corresponding tune of first case for the judging result in the judging unit
Whole parameter, the adjusting parameter is for being adjusted the disease score value of first case；
Computing unit, for calculating first case according to the first foundation disease score value and the adjusting parameter
Disease score value.
In one possible implementation, the disease is classified as the item in disease classifying dictionary, the disease classification
Dictionary includes the classification of M disease and classifies code with the M disease one-to-one M disease of classifying, and the disease is classified
Code is the top N code of ICD coding or ICD coding, and the N is the positive integer less than 6, and M is positive integer.
In another possible implementation, the judging unit is specifically used for:
Judge whether the age of insured people in first case is less than preset value, the generation department of first case is
It is no be paediatrics department, first case generation hospital whether be paediatrics section hospital, the first drug in first case
Dosage whether less than one or more in the first dosage, when the Xiang Douwei of judgement is, insured people in first case
For children.
In another possible implementation, the determination unit is specifically used for:
According to adjusting parameter table search first case belonging to disease classify corresponding the first adjustment parameter, the tune
Whole parameter list includes the classification of N number of disease and classifies one-to-one adjusting parameter with N number of disease, and N is positive integer, and N is little
In M.
In another possible implementation, before the corresponding adjusting parameter of the determination paediatrics, the calculating
Equipment further include: generation unit, for generating the adjusting parameter table, wherein the first disease is classified as N number of disease classification
In the classification of any one disease, the generation unit is specifically used for:
Case collection is received, the case collection includes multiple cases, insured people in any one case in the multiple case
It is the first disease type and including practical medical insurance for children, disease type；
The practical medical insurance of each case is concentrated to calculate the average doctor of the case concentration case according to the case
Premium is used；
The average medical insurance of case is concentrated to calculate the paediatrics basis disease of the first disease type according to the case
Score value, and the corresponding second basic disease score value of the first disease classification is searched in disease score value dictionary table；
The first disease classification pair is calculated according to the paediatrics basis disease score value and the second basic disease score value
The adjusting parameter answered.
Optionally, the corresponding adjusting parameter of the first disease classification is calculated by following formula:
σ1=(A '1-A1)/A1；
Wherein, σ1For the corresponding adjusting parameter of first disease classification, A '1For the paediatrics basis disease score value, A1For
Described second basic disease score value.
In another possible implementation, the computing unit calculates the disease of first case by following formula
Kind score value:
Y=A* σ * C
Wherein, Y is the disease score value of first case, and A is the first foundation disease score value, and σ is first disease
The adjusting parameter of example, C are the hospital grade coefficient of hospital where first case.
The third aspect, the embodiment of the invention also provides a kind of calculating equipment, which includes processor, memory
And communication module, the processor are coupled to the memory, the communication module, the processor is for calling described deposit
The program code of reservoir storage executes:
The case data of the first case are received by communication module；
The corresponding first foundation disease score value of the affiliated disease classification of first case is searched in disease score value dictionary table,
The disease score value dictionary table includes the corresponding relationship of disease classification with basic disease score value；
According to the case load of first case it is judged that whether insured people is children in first case, if so,
Determine the corresponding adjusting parameter of first case, the adjusting parameter is for adjusting the disease score value of first case
It is whole；
The disease score value of first case is calculated according to the first foundation disease score value and the adjusting parameter.
In one possible implementation, the disease is classified as the item in disease classifying dictionary, the disease classification
Dictionary includes the classification of M disease and classifies code with the M disease one-to-one M disease of classifying, and the disease is classified
Code is the top N code of ICD coding or ICD coding, and the N is the positive integer less than 6, and M is positive integer.
In another possible implementation, the processor executes the case data according to first case
Judge that whether insured people is children in first case, specifically includes execution:
Judge whether the age of insured people in first case is less than preset value, the generation department of first case is
It is no be paediatrics department, first case generation hospital whether be paediatrics section hospital, the first drug in first case
Dosage whether less than one or more in the first dosage, when the Xiang Douwei of the calculating equipment judgement is, described first
Insured artificial children in case.
In another possible implementation, the processor executes the corresponding adjusting parameter of the determination paediatrics
Including executing:
According to adjusting parameter table search first case belonging to disease classify corresponding the first adjustment parameter, the tune
Whole parameter list includes the classification of N number of disease and classifies one-to-one adjusting parameter with N number of disease, and N is positive integer, and N is little
In M.
Optionally, before the processor executes the corresponding adjusting parameter of the determination paediatrics, the processor is also
For executing: generating the adjusting parameter table, wherein the first disease is classified as any one disease in N number of disease classification
Kind classification.
Optionally, the processor executes the generation adjusting parameter table and specifically includes execution:
Case collection is received, the case collection includes multiple cases, insured people in any one case in the multiple case
It is the first disease type and including practical medical insurance for children, disease type；
The practical medical insurance of each case is concentrated to calculate the average doctor of the case concentration case according to the case
Premium is used；
The average medical insurance of case is concentrated to calculate the paediatrics basis disease of the first disease type according to the case
Score value, and the corresponding second basic disease score value of the first disease classification is searched in disease score value dictionary table；
The first disease classification pair is calculated according to the paediatrics basis disease score value and the second basic disease score value
The adjusting parameter answered.
Optionally, calculating the corresponding adjusting parameter of the first disease classification by following formula includes:
σ1=(A '1-A1)/A1；
Wherein, σ1For the corresponding adjusting parameter of first disease classification, A '1For the paediatrics basis disease score value, A1For
Described second basic disease score value.
In another possible implementation, include: by the disease score value that following formula calculate first case
Y=A* σ * C
Wherein, Y is the disease score value of first case, and A is the first foundation disease score value, and σ is first disease
The adjusting parameter of example, C are the hospital grade coefficient of hospital where first case.
Fourth aspect, the embodiment of the present application also provides a kind of computer storage medium, the computer storage medium is used
In computer software instructions, the computer software instructions make the computer execute such as first aspect when executed by a computer
Any one described disease score value calculation method based on data analysis.
5th aspect, the embodiment of the present application also provides a kind of computer program, the computer program includes computer
Software instruction, the computer software instructions make times of the computer execution as described in relation to the first aspect when executed by a computer
Anticipate it is a kind of based on data analysis disease score value calculation method.
To sum up, in the embodiment of the present invention, equipment is calculated by the case data of the first case of reception, in disease score value dictionary
The affiliated disease classification corresponding disease basis score value of first case is searched in table, the disease score value dictionary table includes disease
The corresponding relationship of classification and basic disease score value meets the item of the first score value shelves in the case data of first case in turn
When part, the corresponding additional disease score value of the first score value shelves is received, to correspond to according to the affiliated disease classification of first case
Disease basis score value and the additional disease score value calculate the disease score value of first case, realize to disease score value into
One successive step segments disease score value charge method further for the actual conditions of case, meets complicated
Requirement of the case data to disease score value so that the medical payment mode of DRGs-based payment system can effectively be implemented.
Detailed description of the invention
Technical solution in order to illustrate the embodiments of the present invention more clearly or in background technique below will be implemented the present invention
Attached drawing needed in example or background technique is illustrated.
Fig. 1 is the functional frame composition that a kind of medical insurance provided in an embodiment of the present invention manages platform；
Fig. 2 is a kind of flow chart of disease score value calculation method provided in an embodiment of the present invention；
Fig. 3 is the flow chart that a kind of adjusting parameter table provided in an embodiment of the present invention generates；
Fig. 4 is a kind of structural schematic diagram for calculating equipment provided in an embodiment of the present invention；
Fig. 5 is the structural schematic diagram of another calculating equipment provided in an embodiment of the present invention；
Fig. 6 is the structural schematic diagram of another calculating equipment provided in an embodiment of the present invention.
Specific embodiment
In order to enable those skilled in the art to better understand the solution of the present invention, below in conjunction in the embodiment of the present invention
Attached drawing, technical scheme in the embodiment of the invention is clearly and completely described, it is clear that described embodiment is this hair
Bright a part of the embodiment, instead of all the embodiments.Based on the embodiments of the present invention, those of ordinary skill in the art are not having
Every other embodiment obtained under the premise of creative work is made, shall fall within the protection scope of the present invention.
It should be noted that the term used in embodiments of the present invention is only merely for the mesh of description specific embodiment
, it is not intended to limit the invention." the one of the embodiment of the present invention and singular used in the attached claims
Kind ", " described " and "the" are also intended to including most forms, unless the context clearly indicates other meaning.It is also understood that this
Term "and/or" used herein refers to and includes one or more associated any or all possible group for listing project
It closes.
In order to be best understood from the embodiment of the present invention, each of platform first is managed to the medical insurance that the embodiment of the present invention is applicable in below
Function is described, referring to Fig. 1, Fig. 1 is the functional frame composition that a kind of medical insurance provided in an embodiment of the present invention manages platform, it should
Medical insurance management platform, which may operate in, to be calculated in equipment, is that medical insurance manages a series of and case that the operator of platform provides, doctor
The relevant functions such as guarantor, disease score value, the medical insurance manage the realization that platform includes but is not limited to following partly or entirely function:
Disease coding, what medical insurance management platform can obtain diagnosis main in the case according to the case data of Imported cases
Disease is encoded, which can use ICD-10 coding (in the application be also referred to as six codes coding), can also be with
Using other coding methods, such as four code codings (first 4 of i.e. six codes), three code codings (first 3 of i.e. six codes)
Deng.It is appreciated that case collection can occur by a certain area establishes the disease point for being applicable in this area by disease coding method
Category dictionary, the disease classifying dictionary include M disease classification and divide with the one-to-one M disease of M disease classification
Class code, M are positive integer.Optionally, calculating equipment and being managed in land identification case data based on medical insurance has medical worker to fill out
The information such as diagnosis name, the disease coding write recognize the corresponding disease classification of the case, and then disease classification is corresponding
Disease classification code adds in case data, in order to further calculate the disease score value of the case, and then realizes and presses disease
Payment carries out the functions such as the detection of case data validity based on disease score value.
Disease score value calculates, and medical insurance management platform can store the mapping table of disease and disease score value or comprising disease
Kind score value calculation procedure can determine insured people (i.e. patient) institute in the case by disease title, disease coding etc. in case
The classification of illness kind, and then disease is based on according to disease classification and the corresponding relationship of disease score value or disease score value calculation procedure etc.
Classification determines that the realization process of disease score value determines the disease score value of the case.Wherein, disease score value be area (for example, country,
Province or city etc.) based on case big data determine for calculating medical expense (such as prediction medical insurance, prediction total cost etc.)
Standard score.Specifically, can establish disease score table, the disease score table include M disease classification and with the M disease
The one-to-one basic disease score value of classification, further according to actual conditions (such as the serious journey in insured man-year age, illness of case
The information such as degree, place hospital, affiliated department) it is adjusted on the basis of basic disease score value, to obtain being suitble to the case
Disease score value.Disease score value and medical expense correlation, i.e. disease score value is higher, and the medical expense of the disease is higher.
The statistical analysis of case data, medical insurance manages platform can be according to assessment cycle (for example, monthly, season, year
Deng) case that reports to hospital each in this area is for statistical analysis.It is above-mentioned that the statistical analysis of case can be supported monthly
Degree, season, year etc. are for statistical analysis, support to one of Different hospital, different expense section, different diseases etc. or more
The combination of kind carries out the statistical analysis of generation number of cases, total cost, practical medical insurance, prediction medical insurance etc., based on statistics
Analysis result is adjusted the disease score value of each disease used by next assessment cycle.It should be understood that based on statistical analysis
As a result it can also realize to other function, such as based on hospital-grade of the receipts and expenditures to hospital for counting obtained each hospital
Other coefficient is adjusted, in this regard, the embodiment of the present application is not construed as limiting.
The authenticity of case detects, and medical insurance manages platform can be based on the case data in case to the authenticity of the case
It is detected, when detecting that the case includes false data, being marked to the case, exporting the case includes false data
Or the prompting message etc. of abnormal case, in order to which the operator of medical insurance management platform recognizes abnormal case in time, and analyze different
Normal case reason.
Data visualization, the statistic analysis result that medical insurance management platform can obtain the function of statistic analysis of case data
Visualized, can also the result for statistical analysis to problem case visualize, in order to medical insurance management platform
Operator's statistic analysis result.
In the application, calculating equipment can include but is not limited to mobile phone, removable computer, tablet computer, media play
Device, computer, server etc. include the equipment of data processing function.The calculating equipment for running the medical insurance management each function of platform can
To receive the case reported from the mechanisms such as hospital or individual.
It being not limited to shown in Fig. 1, medical insurance management platform provided by the present application can also include the realization of other function, for example,
The optimization etc. of disease score value, in this regard, the embodiment of the present application is not construed as limiting.
Fig. 2 is referred to, Fig. 2 is a kind of disease score value calculation method provided by the present application.In Fig. 2 embodiment, with disease
The executing subject that score value calculates be to describe for calculating equipment the equipment of each function of case management platform (run), Ke Yili
Solution, which calculates the equipment that can also have data processing function by other terminals or server etc., in this regard, the application
Embodiment is not construed as limiting.As shown in Fig. 2, this method can include but is not limited to following part or all of step:
S2: the case data of the first case are received.
Wherein, case is the diagnosing patient therapeutic process that patient record is directed to by hospital.Case data may include but not
It is limited to one of personal information, diagnostic message, treatment information, cost information, practical medical insurance of patient etc. or a variety of
Combination.Wherein, diagnostic message may include the diagnostic marker of sick kind of insured human hair classification for identification.Wherein, diagnostic marker
It can be diagnosis name, such as main diagnosis name；It can also be diagnosis coding, such as ICD diagnosis coding；It can also be operation mark
Knowledge can be operation names, Operation encoding etc..It should be understood that personal information can include but is not limited to age of insured people, gender,
The information such as medical history.Treating information is to record the insured procedural information for ruling treatment by men in case.
In a kind of realization of the application, the case data of the first case include the diagnosis mark of disease classification for identification
Know.That is, the first case, which has passed through disease classifying identification method, recognizes the disease that the disease of the first case is classified and will be recognized
The mark of classification is added in the case data of the first case.The diagnostic marker is mark (the disease systematic name of disease classification
Title or disease classification code).It is appreciated that disease classification be identified as in disease classifying dictionary include disease classification title or
Person's disease is classified code, wherein disease classifying dictionary include M disease specific name and with one a pair of M disease specific name
The M disease classification code answered, M is positive integer.Optionally, disease classification code is ICD coding, which is ICD
Dictionary；Or, disease classification code is the top N code of ICD coding, N is the positive integer less than 6.
For the top N code that disease classification code is ICD coding in disease classifying dictionary, the ICD of disease is selected to encode
First four, front three or the first two position, concentrate the disease of case to be classified as preceding four examples of ICD coding depending on case
Number, for example it is greater than 10, choosing " four codes " is as disease classification code；If choosing " three codes " is as disease classification code less than 10.
In a kind of realization of the application, the first case includes the diagnostic marker of disease classification for identification.After S2, S4 it
Before, this method can also include: S3: calculate equipment according in the first case for identification insured people generations disease classify examine
It is disconnected to identify the disease classification for determining the first case.
S4: searching the corresponding first foundation disease score value of the affiliated disease classification of the first case in disease score value dictionary table,
Wherein, which includes the corresponding relationship of disease classification with basic disease score value.
Specifically, the case data of the first case may include diagnostic marker, and calculating equipment can determine according to the first disease
The diagnostic marker of example determines that disease belonging to first case is classified, and in turn, searches described first in disease score value dictionary table
The corresponding first foundation disease score value of disease classification.
Calculating equipment can determine that the diagnostic marker according to the first case determines the classification of disease belonging to first case
A kind of implementation may is that the diagnostic marker of the first disease may include diagnosis name, and disease name can be prestored by calculating equipment
Claim the table of comparisons, which includes each disease classification pair in M disease classification and M disease classification
The one or more diagnosis names answered.In turn, the diagnosis of the first disease can be determined according to the disease title table of comparisons by calculating equipment
The corresponding disease classification of title determines the corresponding disease of disease classification of the second case according further to disease classifying dictionary
Classification code.
Calculating equipment can determine that the diagnostic marker according to the first case determines the classification of disease belonging to first case
Another implementation may is that the diagnostic marker of the first disease may include diagnosis coding, which can be ICD-
10 codings, ICD-9-CM3 Operation encoding, tumor morphology encode (also referred to as M code) or Chinese medicine disease code etc..
For ICD-10 coding or ICD-9-CM3 Operation encoding, calculating equipment can be directly in disease classifying dictionary
The disease classification code that middle lookup matches with diagnosis coding in the first case.
For M code, M code can be converted to by ICD coding or four ICD codes according to M code conversion table.For example, M code
" M8140/6 " corresponding ICD coding " C78.7 ", the corresponding ICD coding " C34.9 " of M code " M8140/3 ".Calculating equipment can root
The M code in the first case is converted to ICD coding according to M code conversion table, and (ICD coding can be disease in disease classifying dictionary
Classification code is also possible to the ICD coding etc. with six codings), and then search and be converted in disease classifying dictionary
The disease classification code that ICD coding matches.
S6: according to the case load of first case it is judged that insured artificial children in first case, if so, really
Determine the corresponding adjusting parameter of the paediatrics.
Judge whether insured people in first case is that a kind of implementation of children may is that calculating equipment judges institute
State insured people in the first case age whether be less than preset value, first case generation department whether be paediatrics department,
Whether the generation hospital of first case is paediatrics section hospital, whether the dosage of the first drug is less than in first case
It is one or more in first dosage etc., when the Xiang Douwei of judgement is, insured artificial children in first case, otherwise,
First case is the case that non-paediatrics occurs, and the disease score value of the first disease can be calculated by first foundation disease score value.Its
In, preset value can be 12 years old, 10 years old etc..First drug is any one drug for including in the first case, and the first dosage can
To be the adult standard dose using the first drug.
For example, calculating equipment judges whether the age of insured people in the first case is less than preset value (such as 12 years old, 10 years old
Deng) if it is, further judge the dosage of the first drug in first case whether less than the first dosage, if it is,
Judge insured artificial children in the first case, otherwise, the first case is the case that non-paediatrics occurs.
In another example calculating equipment judges whether the generation hospital of the first case is paediatrics section hospital, if it is, into one
Step judges whether the age of insured people in the first case is less than preset value (such as 12 years old, 10 years old etc.) if it is, further sentencing
Whether the dosage of the first drug is less than the first dosage in first case of breaking, if it is, judging insured people in the first case
For children, otherwise, the first case is the case that non-paediatrics occurs.
It is appreciated that classifying for different diseases, corresponding adjusting parameter can be different.Calculating equipment can prestore
Adjusting parameter table, the adjusting parameter table may include the classification of N number of disease and classify one-to-one adjusting parameter with N number of disease.
It calculates equipment and determines that a kind of implementation of the corresponding adjusting parameter of first case may is that calculate equipment joins according to adjustment
Number table searches the corresponding adjusting parameter of the classification of disease belonging to first case, the corresponding adjusting parameter of as the first case.
Wherein, before S6, calculating equipment can also be performed step, and: S1 generates adjusting parameter table.First disease is classified as
Any one disease classification in the classification of N number of disease in adjusting parameter table, the application illustrate by taking the classification of the first disease as an example this
One disease is classified the setting method of corresponding adjusting parameter, specific as follows to include the following steps:
S11: case collection is received, the case collection includes multiple cases, is joined in any one case in the multiple case
Guarantor is children, disease type is the first disease type and including practical medical insurance.
S12: it concentrates the practical medical insurance of each case to calculate the case according to the case and concentrates the flat of case
Equal medical insurance.
S13: the average medical insurance of case is concentrated to calculate the paediatrics basis of the first disease type according to the case
Disease score value, and the corresponding second basic disease score value of the first disease classification is searched in disease score value dictionary table.
Wherein, the calculation of the paediatrics basis disease score value of the first disease type may include:
Wherein, i is the index that case concentrates case, and j is positive integer and the sum for being less than the case that case is concentrated, SiFor disease
Practical medical insurance in example i, δ are constant, and δ is greater than 0.Optionally, the paediatrics basis disease score value and second of the first disease type
The δ that basic disease score value uses when calculating is identical.
S14: first disease point is calculated according to the paediatrics basis disease score value and the second basic disease score value
The corresponding adjusting parameter of class.
Optionally, the corresponding adjusting parameter σ of the first disease classification1The first calculation:
σ1=A '1-A1
Wherein, A '1For paediatrics basis disease score value, A1For the second basic disease score value.
Optionally, the corresponding adjusting parameter σ of the first disease classification1Second of calculation:
σ1=(A '1-A1)/A1
S8: the disease of first case is calculated according to the adjusting parameter of the first foundation disease score value and the first case
Score value.
Wherein, for the adjusting parameter of the first case obtained for the first calculation, the disease point of the first case
Value Y may is that
Y=A+ σ, or, Y=A*C+ σ；
Wherein, A is the first foundation disease score value, and σ is the adjusting parameter of first case, and C is first disease
The hospital grade coefficient of hospital where example.
For the adjusting parameter for the first case that second of calculation obtains, the disease score value Y of the first case can
To be:
Y=A* σ, or, Y=A* σ * C
Optionally, disease has point of weight, same disease classification, different severity, medical treatment required for treating
Resource, expense etc. can be different.For a kind of classification of disease, disease score value can be realized more by additional disease score value
A grade of division, each grade of disease score value it is of different sizes.The disease score value Y of first case may also is that
Wherein, EiTo add disease score value, i is the index of additional disease score value, and i is positive integer.
Optionally, the value of i can default operation, default complication, default to include in the case data of the first case
Secondary disease, the item number of default hospitalization information are related.Such as, the case data of the first case include above-mentioned all items, then i=4.It is attached
Add disease score value that can be set according to the expense of default operation, default complication, default secondary disease, default hospitalization information.
It is appreciated that the disease score value of the first case can be used for calculating the prediction medical insurance of the first case.
To sum up, the embodiment of the present invention calculates the case data that equipment passes through the first case of reception；In disease score value dictionary table
Middle to search the corresponding first foundation disease score value of the affiliated disease classification of first case, the disease score value dictionary table includes disease
The corresponding relationship of kind classification and basic disease score value；According to the case load of first case it is judged that joining in first case
Whether guarantor is children, if so, determining the corresponding adjusting parameter of first case；In turn, according to the first foundation disease
Kind score value and the adjusting parameter calculate the disease score value of first case, realize to the disease score value of paediatrics generation case
Further adjustment optimizes disease score value charge method further for the actual conditions of case, meets multiple
Requirement of the miscellaneous case data to disease score value, so that the medical payment mode of DRGs-based payment system can effectively be implemented.
The device that inventive embodiments are related to is described below.
Please refer to Fig. 4 calculate equipment 40, including but not limited to: receiving unit 41, searching unit 42, judging unit 43, really
Order member 44 and computing unit 45 etc..Wherein,
Receiving unit 41, for receiving the case data of the first case；
Searching unit 42, for searching first case affiliated disease classification corresponding the in disease score value dictionary table
One basic disease score value, the disease score value dictionary table include the corresponding relationship of disease classification with basic disease score value；
Judging unit 43, for according to the case load of first case it is judged that in first case insured people whether
For children；
Determination unit 44 is when being, to determine that first case is corresponding for the judging result in the judging unit
Adjusting parameter, the adjusting parameter is for being adjusted the disease score value of first case；
Computing unit 45, for calculating first case according to the first foundation disease score value and the adjusting parameter
Disease score value.
In one possible implementation, the disease is classified as the item in disease classifying dictionary, the disease classification
Dictionary includes the classification of M disease and classifies code with the M disease one-to-one M disease of classifying, and the disease is classified
Code is the top N code of ICD coding or ICD coding, and the N is the positive integer less than 6, and M is positive integer.
In another possible implementation, the judging unit 43 is specifically used for:
Judge whether the age of insured people in first case is less than preset value, the generation department of first case is
It is no be paediatrics department, first case generation hospital whether be paediatrics section hospital, the first drug in first case
Dosage whether less than one or more in the first dosage, when the Xiang Douwei of judgement is, insured people in first case
For children.
In another possible implementation, the determination unit 44 is specifically used for:
According to adjusting parameter table search first case belonging to disease classify corresponding the first adjustment parameter, the tune
Whole parameter list includes the classification of N number of disease and classifies one-to-one adjusting parameter with N number of disease, and N is positive integer, and N is little
In M.
Calculating equipment shown in fig. 5 is please referred to, it includes each list in calculating equipment 40 shown in Fig. 4 which, which removes,
It is first outer, it can also include: generation unit 46, for generating the adjusting parameter table, wherein the first disease is classified as described N number of
Any one disease classification in disease classification.
Optionally, the generation unit 46 is specifically used for:
Case collection is received, the case collection includes multiple cases, insured people in any one case in the multiple case
It is the first disease type and including practical medical insurance for children, disease type；
The practical medical insurance of each case is concentrated to calculate the average doctor of the case concentration case according to the case
Premium is used；
The average medical insurance of case is concentrated to calculate the paediatrics basis disease of the first disease type according to the case
Score value, and the corresponding second basic disease score value of the first disease classification is searched in disease score value dictionary table；
The first disease classification pair is calculated according to the paediatrics basis disease score value and the second basic disease score value
The adjusting parameter answered.
Optionally, the corresponding adjusting parameter of the first disease classification is calculated by following formula:
σ1=(A '1-A1)/A1；
Wherein, σ1For the corresponding adjusting parameter of first disease classification, A '1For the paediatrics basis disease score value, A1For
Described second basic disease score value.
In another possible implementation, the computing unit 45 calculates first case by following formula
Disease score value:
Y=A* σ * C
Wherein, Y is the disease score value of first case, and A is the first foundation disease score value, and σ is first disease
The adjusting parameter of example, C are the hospital grade coefficient of hospital where first case.
It should be noted that the specific implementation of each unit of above-mentioned calculating equipment may refer in above method embodiment
Associated description, the application repeat no more.
Calculating equipment as shown in FIG. 6, the calculating equipment 600 can include: baseband chip 610, memory 615 (one or
Multiple computer readable storage mediums), communication module 616 (for example, radio frequency (RF) module 6161 and/or communication interface 6162),
Peripheral system 617, communication interface 623.These components can communicate on one or more communication bus 614.
Peripheral system 617 is mainly used for realizing the interactive function calculated between equipment 610 and user/external environment, mainly
Input/output device including calculating equipment 600.In the specific implementation, peripheral system 617 can include: touch screen controller 618,
Camera controller 619, Audio Controller 620 and sensor management module 621.Wherein, each controller can with respectively it is right
Peripheral equipment (such as touch screen 623, camera 624, the voicefrequency circuit 625 and sensor 626) coupling answered.It should be noted that
Peripheral system 617 can also include other I/O peripheral hardwares.
It includes: one or more processors 611, clock module 622 and power management module that baseband chip 610, which can integrate,
613.The clock module 622 being integrated in baseband chip 610 is mainly used for generating data transmission and timing control for processor 611
Required clock.The power management module 613 being integrated in baseband chip 610 is mainly used for as processor 611, radio-frequency module
6161 and peripheral system stable, pinpoint accuracy voltage is provided.
Radio frequency (RF) module 6161 is mainly integrated with the receiver for calculating equipment 600 for sending and receiving radiofrequency signal
And transmitter.Radio frequency (RF) module 6161 passes through radiofrequency signal and communication network and other communication apparatus communications.In the specific implementation,
Radio frequency (RF) module 6161 may include but be not limited to: antenna system, RF transceiver, one or more amplifiers, tuner, one
Or multiple oscillators, digital signal processor, CODEC chip, SIM card and storage medium etc..It in some embodiments, can be in list
Radio frequency (RF) module 6161 is realized on only chip.
Communication module 616 is used to calculate the data exchange between equipment 600 and other equipment.
Memory 615 is coupled with processor 611, for storing various software programs and/or multiple groups instruction.Specific implementation
In, memory 615 may include the memory of high random access, and may also comprise nonvolatile memory, such as one or
Multiple disk storage equipments, flash memory device or other non-volatile solid-state memory devices.Memory 615 can store an operating system
(following abbreviation systems), such as the embedded OSs such as ANDROID, IOS, WINDOWS or LINUX.Memory 615 is also
It can store network communication program, which can be used for calculating with one or more optional equipments, one or more
Equipment equipment, one or more network equipments are communicated.Memory 615 can also store user interface program, which connects
Mouthful program can show by patterned operation interface by the content image of application program is true to nature, and by menu,
The input controls such as dialog box and key receive user and operate to the control of application program.
Memory 615 can also store one or more application program.As shown in fig. 6, these application programs can include: society
It hands over application program (such as Facebook), image management application (such as photograph album), map class application program (such as Google
Figure), browser (such as Safari, Google Chrome) etc..
In the application, processor 611 can be used for reading and executing computer-readable instruction.Specifically, processor 611 can be used
In the program that calling is stored in memory 615, such as the realization program of disease score value calculation method provided by the present application, and hold
The instruction that the row program includes.
Specifically, processor 611 can be used for calling the program being stored in memory 615, such as disease provided by the present application
The realization program of score value calculation method, and execute following processes:
The case data of the first case are received by communication module 616；
The corresponding first foundation disease score value of the affiliated disease classification of first case is searched in disease score value dictionary table,
The disease score value dictionary table includes the corresponding relationship of disease classification with basic disease score value；
According to the case load of first case it is judged that whether insured people is children in first case, if so,
Determine the corresponding adjusting parameter of first case, the adjusting parameter is for adjusting the disease score value of first case
It is whole；
The disease score value of first case is calculated according to the first foundation disease score value and the adjusting parameter.
In one possible implementation, the disease is classified as the item in disease classifying dictionary, the disease classification
Dictionary includes the classification of M disease and classifies code with the M disease one-to-one M disease of classifying, and the disease is classified
Code is the top N code of ICD coding or ICD coding, and the N is the positive integer less than 6, and M is positive integer.
In another possible implementation, the processor 611 executes the case according to first case
Data judge that whether insured people is children in first case, specifically includes execution:
Judge whether the age of insured people in first case is less than preset value, the generation department of first case is
It is no be paediatrics department, first case generation hospital whether be paediatrics section hospital, the first drug in first case
Dosage whether less than one or more in the first dosage, when the Xiang Douwei of the calculating equipment judgement is, described first
Insured artificial children in case.
In another possible implementation, the processor 611 executes the corresponding adjustment of the determination paediatrics
Parameter includes executing:
According to adjusting parameter table search first case belonging to disease classify corresponding the first adjustment parameter, the tune
Whole parameter list includes the classification of N number of disease and classifies one-to-one adjusting parameter with N number of disease, and N is positive integer, and N is little
In M.
Optionally, before the processor 611 executes the corresponding adjusting parameter of the determination paediatrics, the processor
611 are also used to execute: generating the adjusting parameter table, wherein the first disease is classified as any one in N number of disease classification
A disease classification.
Optionally, the processor 611 executes the generation adjusting parameter table and specifically includes execution:
Case collection is received by communication module 616, the case collection includes multiple cases, any one in the multiple case
Insured artificial children, disease type are for the first disease type and including practical medical insurance in a case；
The practical medical insurance of each case is concentrated to calculate the average doctor of the case concentration case according to the case
Premium is used；
The average medical insurance of case is concentrated to calculate the paediatrics basis disease of the first disease type according to the case
Score value, and the corresponding second basic disease score value of the first disease classification is searched in disease score value dictionary table；
The first disease classification pair is calculated according to the paediatrics basis disease score value and the second basic disease score value
The adjusting parameter answered.
Optionally, calculating the corresponding adjusting parameter of the first disease classification by following formula includes:
σ1=(A '1-A1)/A1；
Wherein, σ1For the corresponding adjusting parameter of first disease classification, A '1For the paediatrics basis disease score value, A1For
Described second basic disease score value.
In another possible implementation, include: by the disease score value that following formula calculate first case
Y=A* σ * C
Wherein, Y is the disease score value of first case, and A is the first foundation disease score value, and σ is first disease
The adjusting parameter of example, C are the hospital grade coefficient of hospital where first case.
It is appreciated that the specific implementation of above-mentioned each process and each functional unit is referred in above method embodiment
Associated description, the embodiment of the present application repeat no more.
It should be appreciated that calculating equipment 600 is only an example provided in an embodiment of the present invention, also, calculating equipment 600 can
With the more or fewer components of component than showing, two or more components can be combined, or there can be component not
It is realized with configuration.
In the above-described embodiments, it all emphasizes particularly on different fields to the description of each embodiment, there is no the portion being described in detail in some embodiment
Point, reference can be made to the related descriptions of other embodiments.
Those of ordinary skill in the art will appreciate that realizing all or part of the process in above-described embodiment method, being can be with
Relevant hardware is instructed to complete by computer program, the program can be stored in a computer-readable storage medium
In, the program is when being executed, it may include such as the process of the embodiment of above-mentioned each method.Wherein, the storage medium can be magnetic
Dish, CD, read-only memory (Read-Only Memory, ROM) or random access memory (Random Access
Memory, RAM) etc..
The steps in the embodiment of the present invention can be sequentially adjusted, merged and deleted according to actual needs.
Module in the device of that embodiment of the invention can be combined, divided and deleted according to actual needs.
The above, the above embodiments are merely illustrative of the technical solutions of the present invention, rather than its limitations；Although referring to before
Stating embodiment, invention is explained in detail, those skilled in the art should understand that: it still can be to preceding
Technical solution documented by each embodiment is stated to modify or equivalent replacement of some of the technical features；And these
It modifies or replaces, the range for technical solution of various embodiments of the present invention that it does not separate the essence of the corresponding technical solution.
Claims (10)
1. a kind of disease score value calculation method based on data analysis characterized by comprising
Calculate the case data that equipment receives the first case；
The calculating equipment searches the corresponding first foundation of the affiliated disease classification of first case in disease score value dictionary table
Disease score value, the disease score value dictionary table include the corresponding relationship of disease classification with basic disease score value；
It is described to calculate equipment according to the case load of first case it is judged that whether insured people is children in first case,
If so, determining the corresponding adjusting parameter of first case, the adjusting parameter is used for the disease point to first case
Value is adjusted；
The disease for calculating equipment and calculating first case according to the first foundation disease score value and the adjusting parameter
Score value, the disease score value of first case are used to calculate the prediction medical insurance of first case.
2. the method as described in claim 1, which is characterized in that the disease is classified as the item in disease classifying dictionary, described
Disease classifying dictionary includes the classification of M disease and classifies code with the M disease one-to-one M disease of classifying, described
Disease classification code is that ICD is encoded or the top N code of ICD coding, the N are the positive integer less than 6, and M is positive integer.
3. method according to claim 1 or 2, which is characterized in that the equipment that calculates is according to the case of first case
Data judge that whether insured people is children in first case, is specifically included:
The calculating equipment judges whether the age of insured people in first case is less than the hair of preset value, first case
Raw department whether be paediatrics department, first case generation hospital whether be paediatrics section hospital, in first case
Whether the dosage of the first drug is less than one or more in the first dosage, when the Xiang Douwei of the calculating equipment judgement is,
Insured artificial children in first case.
4. the method according to claim 1, which is characterized in that the corresponding adjusting parameter of the determination paediatrics
Include:
The calculating equipment according to adjusting parameter table search first case belonging to disease classify corresponding the first adjustment ginseng
Number, the adjusting parameter table include the classification of N number of disease and classify one-to-one adjusting parameter with N number of disease, and N is positive whole
Number, N are not more than M.
5. method as claimed in claim 4, which is characterized in that before the corresponding adjusting parameter of the determination paediatrics, institute
State method further include: generate the adjusting parameter table, wherein the first disease is classified as any one in N number of disease classification
A disease classification, the generation adjusting parameter table include:
Case collection is received, the case collection includes multiple cases, insured artificial youngster in any one case in the multiple case
Virgin, disease type is for the first disease type and including practical medical insurance；
The practical medical insurance of each case is concentrated to calculate the average medical insurance expense of the case concentration case according to the case
With；
The average medical insurance of case is concentrated to calculate the paediatrics basis disease score value of the first disease type according to the case,
And the corresponding second basic disease score value of the first disease classification is searched in disease score value dictionary table；
It is corresponding that the first disease classification is calculated according to the paediatrics basis disease score value and the second basic disease score value
Adjusting parameter.
6. method as claimed in claim 5, which is characterized in that described according to the paediatrics basis disease score value and described second
Basic disease score value calculates the corresponding adjusting parameter of the first disease classification
σ1=(A '1-A1)/A1；
Wherein, σ1For the corresponding adjusting parameter of first disease classification, A '1For the paediatrics basis disease score value, A1It is described
Second basic disease score value.
7. the method as described in claim 1, which is characterized in that the calculating equipment according to the first foundation disease score value and
The disease score value that the adjusting parameter calculates first case includes:
Y=A* σ * C
Wherein, Y is the disease score value of first case, and A is the first foundation disease score value, and σ is first case
Adjusting parameter, C are the hospital grade coefficient of hospital where first case.
8. a kind of calculating equipment, which is characterized in that including processor, memory and communication module, the processor couples institute
Memory, the communication module are stated, the processor is used to that the program code of the memory storage to be called to execute as right is wanted
Seek the disease score value calculation method based on data analysis described in any one of 1-7 claim.
9. a kind of calculating equipment, which is characterized in that including for realizing as claimed in any one of claims 1-7
The functional unit of disease score value calculation method.
10. a kind of computer storage medium, which is characterized in that the computer storage medium is used for computer software instructions, institute
Stating computer software instructions when executed by a computer executes the computer such as any one of claim 1-7 claim
The disease score value calculation method based on data analysis.
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