CN109544374A - A kind of disease score value method of adjustment and calculating equipment based on big data - Google Patents
A kind of disease score value method of adjustment and calculating equipment based on big data Download PDFInfo
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Abstract
The embodiment of the invention discloses a kind of disease score value method of adjustment and calculating equipment based on big data, this method comprises: calculating equipment receives case collection, case collection is the set for the case that the disease classification that the first area generates within the first assessment cycle belongs to the classification of the first disease, and it includes practical medical insurance that case, which concentrates case,；The disease score value of each case in case collection is calculated according to the basic disease score value of the first disease classification；First total medical insurance of case collection is calculated according to the disease score value of all cases in case collection, and second total medical insurance of case collection is calculated according to the practical medical insurance of all cases in case collection；In turn, the first foundation disease score value of the first disease classification is adjusted according to first total medical insurance and second total medical insurance, to realize that the first foundation disease score value by adjusting after calculates the disease score value of the case for belonging to the classification of the first disease generated within the second assessment cycle, the accuracy of disease score value is improved.
Description
Technical field
The present invention relates to medical control technical fields, and in particular to a kind of disease score value method of adjustment based on big data 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, detection and analysis case, medical standardized payment etc. are all current technical problems urgently to be solved.
Summary of the invention
The embodiment of the invention provides a kind of disease score value method of adjustment and calculating equipment based on big data, for case
Big data, first total medical insurance of the case for belonging to the classification of the first disease calculated by disease score value and by real in case
What border medical insurance calculated belongs to second total medical insurance of the case of the first disease classification to adjust the disease of the first disease classification
Kind score value carries out disease score value according to the variation of currently practical medical conditions to realize the adjustment to disease score value
Adjustment improves the accuracy of disease score value.
In a first aspect, the embodiment of the present invention provides a kind of disease score value method of adjustment based on big data, comprising:
It calculates equipment and receives case collection, the case collection is the disease classification that the first area generates within the first assessment cycle
Belong to the set of the case of the first disease classification, the case concentrates any one case to include at least practical medical insurance；
The calculating equipment calculates each in the case collection according to the basic disease score value that first disease is classified
The disease score value of case；
It is described calculate equipment according to the disease score value of all cases in the case collection calculate the case collection it is first total
Medical insurance, and calculate according to the practical medical insurance of all cases in the case collection second total medical insurance expense of the case collection
With；
The calculating equipment is according to described first total medical insurance and second total medical insurance adjustment first disease
The first foundation disease score value of kind classification, first foundation disease score value adjusted are commented for calculating first area second
Estimate the disease score value that the disease generated in the period is classified as the case of the first disease classification.
In a kind of realization of the application, second assessment cycle is first assessment cycle or first assessment
Next assessment cycle in period.
In another realization of the application, first disease is classified as the item in disease classifying dictionary, the disease
Classifying dictionary includes the classification of multiple diseases and classifies one-to-one disease classification code with the multiple disease, the disease point
Class code is that ICD is encoded or the top N code of ICD coding, the N are the positive integer less than 6.
In another realization of the application, the case collection includes case i, the calculation formula of the disease score value of case i
Are as follows: Yi=A*Ci+Ei；
Wherein, i is the index that the case concentrates case, and i is positive integer, YiFor the disease score value of case i, the case
I is case in the described first sub- case collection, and A is the first foundation disease score value, CiFor the hospital of hospital where the case i
Classification coefficient, EiFor the additional disease score value of the case i.
Optionally, the calculation method of described first total medical insurance are as follows: S1=∑iYi*D；
The calculation method of second total medical insurance are as follows: S2=∑iTi
Wherein, S1For described first total medical insurance, D is score value unit price, S2For described second total medical insurance, TiFor institute
State the practical medical insurance of case i.
In another realization of the application, the calculating equipment is according to described first total medical insurance and described second total
Before medical insurance adjusts the first foundation disease score value of the first disease classification, the method also includes:
Judge whether the ratio of described first total medical insurance and second total medical insurance is greater than first threshold and small
In second threshold, if it is, the triggering calculating equipment execution is described according to described first total medical insurance and described second
Total medical insurance adjusts the step of the first disease classification corresponding first foundation disease score value.
Optionally, the calculating equipment is according to described first total medical insurance and second total medical insurance adjustment
First disease classification first foundation disease score value include:
A '=A* σ
Wherein, A ' is first foundation disease score value adjusted, and A is the first foundation disease score value, and σ is adjustment ginseng
Number, σ > 0.
Optionally, the adjusting parameter σ makes be calculated according to the first foundation disease score value adjusted
The ratio of three total medical insurances and second total medical insurance is greater than first threshold and is less than second threshold.
Second aspect, the embodiment of the present application also provides a kind of calculating equipment, comprising:
Receiving unit, for receiving case collection, the case collection is the disease that the first area generates within the first assessment cycle
Kind classification belongs to the set of the case of the first disease classification, and the case concentrates any one case to include at least practical medical insurance expense
With；
First computing unit, the basic disease score value for being classified according to first disease calculate every in the case collection
The disease score value of one case；
Second computing unit, for calculating the of the case collection according to the disease score value of all cases in the case collection
One total medical insurance；
Third computing unit, for calculating the case collection according to the practical medical insurance of all cases in the case collection
Second total medical insurance；
Adjustment unit, for according to described first total medical insurance and second total medical insurance adjustment first disease
The first foundation disease score value of kind classification, first foundation disease score value adjusted are commented for calculating first area second
Estimate the disease score value that the disease generated in the period is classified as the case of the first disease classification.
In a kind of realization of the application, second assessment cycle is first assessment cycle or first assessment
Next assessment cycle in period.
In another realization of the application, first disease is classified as the item in disease classifying dictionary, the disease
Classifying dictionary includes the classification of multiple diseases and classifies one-to-one disease classification code with the multiple disease, the disease point
Class code is that ICD is encoded or the top N code of ICD coding, the N are the positive integer less than 6.
In another realization of the application, the case collection includes case i, the calculation formula of the disease score value of case i
Are as follows: Yi=A*Ci+Ei；
Wherein, i is the index that the case concentrates case, and i is positive integer, YiFor the disease score value of case i, the case
I is case in the described first sub- case collection, and A is the first foundation disease score value, CiFor the hospital of hospital where the case i
Classification coefficient, EiFor the additional disease score value of the case i.
Optionally, the calculation method of described first total medical insurance are as follows: S1=∑iYi*D；
The calculation method of second total medical insurance are as follows: S2=∑iTi
Wherein, S1For described first total medical insurance, D is score value unit price, S2For described second total medical insurance, TiFor institute
State the practical medical insurance of case i.
In another realization of the application, the calculating equipment further include:
Judging unit, for judging whether described first total medical insurance and the ratio of second total medical insurance are greater than
First threshold and be less than second threshold, if it is, trigger the adjustment unit execute it is described according to described first total medical insurance expense
The corresponding first foundation disease score value of the first disease classification is adjusted with described second total medical insurance.
Optionally, the adjustment unit is specifically used for adjusting the first foundation of the first disease classification by following formula
Disease score value includes:
A '=A* σ
Wherein, A ' is first foundation disease score value adjusted, and A is the first foundation disease score value, and σ is adjustment ginseng
Number, σ > 0.
Optionally, the adjusting parameter σ makes be calculated according to the first foundation disease score value adjusted
The ratio of three total medical insurances and second total medical insurance is greater than first threshold and is less than second threshold.
The third aspect, the embodiment of the present application also provides a kind of calculating equipment, including processor, memory and communication mould
Block, the processor couple the memory, communication module, and the processor is used to call the program generation of the memory storage
Code executes:
Case collection is received by the communication module, the case collection is that the first area generates within the first assessment cycle
Disease classification belongs to the set of the case of the first disease classification, and the case concentrates any one case to include at least practical medical insurance
Expense；
The disease point of each case in the case collection is calculated according to the basic disease score value that first disease is classified
Value；
First total medical insurance of the case collection, and root are calculated according to the disease score value of all cases in the case collection
Second total medical insurance of the case collection is calculated according to the practical medical insurance of all cases in the case collection；
The first of the first disease classification is adjusted according to described first total medical insurance and second total medical insurance
Basic disease score value, first foundation disease score value adjusted generate within the second assessment cycle for calculating first area
Disease be classified as first disease classification case disease score value.
In a kind of realization of the application, second assessment cycle is first assessment cycle or first assessment
Next assessment cycle in period.
In another realization of the application, first disease is classified as the item in disease classifying dictionary, the disease
Classifying dictionary includes the classification of multiple diseases and classifies one-to-one disease classification code with the multiple disease, the disease point
Class code is that ICD is encoded or the top N code of ICD coding, the N are the positive integer less than 6.
In another realization of the application, the case collection includes case i, the calculation formula of the disease score value of case i
Are as follows: Yi=A*Ci+Ei；
Wherein, i is the index that the case concentrates case, and i is positive integer, YiFor the disease score value of case i, the case
I is case in the described first sub- case collection, and A is the first foundation disease score value, CiFor the hospital of hospital where the case i
Classification coefficient, EiFor the additional disease score value of the case i.
Optionally, the calculation method of described first total medical insurance are as follows: S1=∑iYi*D；
The calculation method of second total medical insurance are as follows: S2=∑iTi
Wherein, S1For described first total medical insurance, D is score value unit price, S2For described second total medical insurance, TiFor institute
State the practical medical insurance of case i.
In another realization of the application, the processor executes described according to described first total medical insurance and described
Before second total medical insurance adjusts the first foundation disease score value of the first disease classification, the processor is also used to hold
Row:
Judge whether the ratio of described first total medical insurance and second total medical insurance is greater than first threshold and small
In second threshold, if it is, trigger the processor execute it is described according to described first total medical insurance and described second total
Medical insurance adjusts the step of the first disease classification corresponding first foundation disease score value.
Optionally, the processor executes described according to described first total medical insurance and second total medical insurance tune
The first foundation disease score value of whole first disease classification includes:
A '=A* σ
Wherein, A ' is first foundation disease score value adjusted, and A is the first foundation disease score value, and σ is adjustment ginseng
Number, σ > 0.
Optionally, the adjusting parameter σ makes be calculated according to the first foundation disease score value adjusted
The ratio of three total medical insurances and second total medical insurance is greater than first threshold and is less than second threshold.
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 method of adjustment based on big data.
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
It anticipates a kind of disease score value method of adjustment based on big data.
To sum up, the embodiment of the present invention provides a kind of disease score value method of adjustment based on big data and calculates equipment, for
The case big data that first assessment cycle (such as a upper assessment cycle in evaluation period) generates, passes through disease score value meter
Calculate the first disease classification first total medical insurance and by medical insurance practical in case calculate the first disease classify
Second total medical insurance come adjust the first disease classification first foundation disease score value, its object is to first by adjusting after
Basic disease score value come calculate the second assessment cycle (such as evaluation period) generation case disease score value, with realize pair
The adjustment of the disease score value of the case generated in second assessment cycle, allows disease score value according to currently practical medical conditions
Variation be adjusted, improve disease score value accuracy.
Detailed description of the invention
In order to more clearly explain the embodiment of the invention or the technical proposal in the existing technology, to embodiment or will show below
There is attached drawing needed in technical description to be briefly described, it should be apparent that, the accompanying drawings in the following description is the present invention
Some embodiments for those of ordinary skill in the art without creative efforts, can also basis
These attached drawings obtain other attached drawings.
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 method of adjustment provided in an embodiment of the present invention；
Fig. 3 is the flow chart of another disease score value method of adjustment provided in an embodiment of the present invention；
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, disease classifying dictionary include the title of M disease classification and the one-to-one M of title with M disease classification
A disease classification code, M is positive integer.Optionally, calculating equipment and being managed in land identification case data based on medical insurance has doctor
The information such as diagnosis name, disease coding that business personnel fill in recognize the corresponding disease classification of the case, and then the disease is divided
The corresponding disease classification code of class adds in case data, in order to further calculate the disease score value of the case, Jin Ershi
Existing DRGs-based payment system 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 value dictionary, which includes the mark and M of M disease classification
The one-to-one relationship of a basis disease score value, 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
Prompting message etc., in order to which the operator of medical insurance management platform recognizes problem case, and problem analysis case reason in time.
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.
The embodiment of the present invention provides a kind of disease score value method of adjustment based on big data and calculates equipment, comments for first
The disease for estimating period (such as a upper assessment cycle in evaluation period) generation is classified as the case collection of the first disease classification,
First total medical insurance of the first disease classification calculated by disease score value and by medical insurance practical in case calculating
Second total medical insurance of the first disease classification adjusts the first foundation disease score value of the first disease classification, and its object is to logical
First foundation disease score value adjusted is crossed to calculate the disease of the case of the second assessment cycle (such as evaluation period) generation
Kind of score value, to realize the adjustment to the disease score value of the case generated in the second assessment cycle, allow disease score value according to
The variation of currently practical medical conditions is adjusted, and improves the accuracy of disease score value.
Fig. 2 is referred to, Fig. 2 is a kind of process signal of disease score value method of adjustment based on big data provided by the present application
Figure.It is to calculate equipment (it is each to run case management platform with the executing subject of disease score value method of adjustment in Fig. 2 embodiment
The equipment of function) for describe, it will be understood that the disease score value method of adjustment can also have by other terminals or server etc.
The equipment of standby data processing function, in this regard, the embodiment of the present application is not construed as limiting.As shown in Fig. 2, this method may include but unlimited
In following part or all of step:
S2: receiving case collection, and case collection is that the disease classification that the first area generates within the first assessment cycle belongs to first
The set of the case of disease classification, case concentrate any one case to include at least practical medical insurance.
Case collection belongs to the first disease point in the disease classification that the first assessment cycle occurred for each hospital in the first area
The set of the case of class, the first area can be Beijing, Shenzhen, Guangdong Province etc. and determined by the operator of medical insurance management platform
Region.Assessment cycle can be the time intervals such as week, the moon, season or year, and the first assessment cycle can be where current time
The upper assessment cycle of assessment cycle.
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.Cost information is including but not limited to insured
One in Operation Fee, cost of hospitalization, check fee, registration fee, drug expense, total cost that people generates in this treatment of diseases etc.
Kind or a variety of combinations.
Specifically, the features of the case data can be identified according to case data and extract by calculating equipment, this feature can be with
Including but not limited to diagnostic marker, medicine mark, drug dose, drug expenditure, the mark of detection, detection expense, operation
Mark, surgery cost, length of stay, hospitalization cost, complication mark, secondary disease mark, insured man-year age, insured human nature are not etc.
One of or a variety of combinations.
Optionally, the second assessment cycle was next assessment cycle of first assessment cycle or the first assessment cycle.
It is appreciated that calculating what equipment can be generated by the first assessment cycle (such as a upper assessment cycle in evaluation period)
Case realizes the adjustment to basis disease score value used in the first assessment cycle or evaluation period.
In the embodiment of the present application, it is ill that calculating equipment can receive the institute generated to the first area in the first assessment cycle
Example, the mark of all cases all added disease classification, i.e., the disease classification of identified each case, case collection be from
The disease that first area is screened in all cases that the first assessment cycle generated is classified as the case of the first disease classification
Collection.In another embodiment of the application, case concentrates case that can not add disease class indication, and calculating equipment can basis
Diagnostic marker in disease classifying dictionary and case recognizes the disease classification of the case.
First disease is classified as the item in disease classifying dictionary, the disease classifying dictionary include the classification of multiple diseases and with
The multiple one-to-one disease classification code of disease classification, disease classification code are the top N code that ICD is encoded or ICD is encoded, institute
Stating 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 first four of ICD coding depending on sample case
Number of cases, for example it is greater than 10, choosing " four codes " is as disease classification code；If choosing " three codes " is classified as disease less than 10
Code.The coding mode of disease classification can reduce disease classification, obtain the medical environment more close to current medical area, make
It obtains the mode classification of disease classification and locality can be preferably applied for by the disease means of payment.
S4: the disease score value of each case in case collection is calculated according to the basic disease score value of the first disease classification.
Specifically, disease score value dictionary can be prestored by calculating equipment, the disease score value dictionary include the classification of multiple diseases with
And classify one-to-one basic disease score value with multiple disease, calculating equipment can be according to disease score value dictionary lookup to the
The corresponding basic disease score value of one disease classification, i.e. the first disease score value.
Wherein, basic disease score value is used to calculate the disease score value of case, however, in multiple cases of same disease classification
The possible treatment means that are different, using of the severity of insured people's illness may have biggish difference, therefore, for same disease
Multiple cases of kind classification, disease score value can be different, it is possible to include special circumstances, can be opened by additional disease score value
Embody the difference of disease score value between multiple cases of same disease classification.
For example, when believing in the case data of case i comprising default operation, default complication, default secondary disease, default be hospitalized
One or more in breath etc., the disease score value of case i needs to increase the corresponding additional disease score value of item that case i includes.
Optionally, case collection includes case i, the calculation formula of the disease score value of case i are as follows:
Yi=A*Ci+Ei；
Wherein, i is the index that case concentrates case, and i is positive integer, YiFor the disease score value of case i, case i is case
Case in collecting, A are first foundation disease score value, CiFor the hospital grade coefficient of hospital where case i, EiFor the additional disease of case i
Kind score value, S1For first total medical insurance, D is score value unit price.
Optionally, the default operation is the specified operation of the operation mark in operation list (for example, difficulty is biggish
Operation, surgery cost are greater than the operation of preset cost (such as 30,000 yuan)), the operation list includes one or more operation marks
Know；The default complication is the classification of disease specified by the disease class indication in complication list, the complication list
Including one or more disease class indications；The default secondary disease is specified by the disease class indication in secondary disease list
Disease classification, the secondary disease list include one or more disease class indications；What the default hospitalization information included is hospitalized
Number of days is greater than the first duration.Wherein, the first duration can be 7 days, 10 days, 22 days, 30 days or other number of days etc., in this regard, this Shen
It please be not construed as limiting.
It should be noted that disease score value can also include other calculations, such as Yi=A*CiDeng the application implementation
Example is not construed as limiting.
S6: first total medical insurance of case collection is calculated according to the disease score value of all cases in case collection, and according to disease
The practical medical insurance that example collects interior all cases calculates second total medical insurance of case collection.
It is appreciated that the prediction medical insurance of case i is the disease score value of case i and the product of score value unit price, first total doctor
Premium is the sum of the prediction medical insurance of all cases in case collection, and second total medical insurance is all cases in case collection
The sum of practical medical insurance.
Optionally, the calculation method of first total medical insurance are as follows:
S1=∑iYi*D；
Wherein, S1For described first total medical insurance, D is score value unit price.
It is appreciated that D can be fixed value, can also change with the variation of total score.Determine a kind of implementation of D
It is: calculates total disease score value Y that case occurs in the first assessment cycle for the first areaAlways, further according to master control expense (the i.e. first area
It can be used for the total cost S of medical insurance in the first assessment cycleAlways) calculate score value unit price D, it may be assumed that
Wherein, YjFor the disease score value of first area j-th of case in the set that case occurs for the first assessment cycle, j
For the index of disease, j is positive integer.
The calculation method of second total medical insurance are as follows:
Wherein, S2For second total medical insurance, TiFor the practical medical insurance of case i.
S8: the first foundation disease point of the first disease classification is adjusted according to first total medical insurance and second total medical insurance
Value, wherein first foundation disease score value adjusted is used to calculate the disease point that the first area generates within the second assessment cycle
Class is the disease score value of the case of the first disease classification.
It is appreciated that illustrating the master control expense in first area when first total medical insurance is greater than second total medical insurance
The medical insurance that the classification of the first disease is allocated in is greater than the practical medical insurance submitted an expense account of case of the first disease classification, this
All hospitals integrally get a profit in the case that the first disease is classified in one area, need to reduce the basis of the first disease classification at this time
Disease score value.However, illustrating to be allocated in whole city's master control expense when first total medical insurance is less than second total medical insurance
The expense of one disease classification is classified the medical insurance actually submitted an expense account less than the first disease, and all hospitals are first in first area
It is lost in the case of disease classification, needs to improve the basic disease score value of the first disease classification at this time.And when first total medical insurance expense
When with being equal to second total medical insurance or smaller difference, illustrate to be allocated to the classification of the first disease in the master control expense in first area
Expense be at or about the first disease and classify the medical insurance actually submitted an expense account, for corresponding first disease classification, basis disease
Rationally, the basic disease score value of the first disease classification at this time can be constant for kind score value price.
Optionally, calculating equipment, can also to export instruction first foundation disease score value setting excessively high, too low or appropriate mention
Show information.
In one embodiment of the invention, before step S8, this method can also include S71 or S72.Also referring to Fig. 3 institute
The flow diagram for another disease score value method of adjustment shown.
S71: judge whether the ratio of described first total medical insurance and second total medical insurance is greater than first threshold and small
In second threshold.
Wherein, first threshold is less than second threshold, and first threshold can be 0.1-0.9, for example, 0.4,0.5,0.7 or other
Numerical value, the embodiment of the present application are not construed as limiting.The value range of second threshold can be 1.1-3, for example, 1.5,2,2.4 or other
Numerical value, the embodiment of the present application are not construed as limiting.
S72: judge whether described first total medical insurance and the difference of second total medical insurance are greater than third threshold value.
Wherein, third threshold value can be 10,000,20,000,3.5 ten thousand or other numerical value etc..Optionally, third threshold value P can basis
First total medical insurance or second total medical insurance setting, for example, P=S1* μ, wherein 0 < μ < 1, for example, for 0.1,0.2,
0.25 or other numerical value etc., the embodiment of the present application is not construed as limiting.
When the judging result of step S71 or S72, which are, is, triggering calculates equipment and executes step S8, otherwise, terminates process.
Wherein, a kind of implementation of the first foundation disease score value of the first disease of adjustment classification may is that
A '=A* σ
Wherein, A ' is first foundation disease score value adjusted, and A is the first foundation disease score value before adjustment, and σ is adjustment
Parameter, σ > 0.
Optionally, adjusting parameter σ makes the total medical insurance being calculated according to first foundation disease score value adjusted
It is greater than first threshold Q with the ratio of second total medical insurance1And it is less than second threshold Q2.That is, adjusting parameter σ makes following conditions
It sets up:
Wherein, S1'=∑iYi' * D, Yi'=A ' * Ci+Ei, Yi' for according to first foundation disease score value adjusted calculating
The disease score value of obtained disease i, S1' the first disease to be recalculated according to basis disease score value A ' adjusted is divided
Total medical insurance of class, i are the index that case concentrates case, and i is positive integer, and case i is case in case collection, CiFor case i
The hospital grade coefficient of place hospital, EiFor the additional disease score value of case i, D is score value unit price.
Optionally, adjusting parameter σ can also be so that being calculated according to first foundation disease score value adjusted total
The difference of medical insurance and second total medical insurance is less than the value of third threshold value.
Optionally,That is, ∑i(A*σ*Ci+Ei) * D=∑iTi。
It should be noted that the embodiment of the present invention can also include other adjustment modes, for example, the first area of adjustment is total
Control expense recalculates score value unit price, so that being calculated according to score value unit price adjusted by first foundation disease score value
Total medical insurance and second total medical insurance ratio be greater than first threshold and be less than second threshold.
In one embodiment of the invention, calculating equipment can also be according to recalculating the of the classification of the first disease with case collection
One basic disease score value, the first foundation disease score value recalculated is first foundation disease score value adjusted.It can
To understand, the first foundation disease score value A ' adjusted are as follows:
Wherein, P is the number of cases that case concentrates case, and D ' can be equal to D, can also be based on the first area in the first assessment week
The set and master control expense for the case that phase obtains recalculate score value unit price.
As it can be seen that the embodiment of the present invention was produced for the first assessment cycle (such as a upper assessment cycle in evaluation period)
Raw disease is classified as the case collection of the first disease classification, first total medical insurance of the case collection calculated by disease score value and
The first base of the first disease classification is adjusted by second total medical insurance of the case collection of medical insurance practical in case calculating
Plinth disease score value calculates the second assessment cycle (such as evaluation period) with the first foundation disease score value by adjusting after
The disease score value of the case of generation realizes the adjustment to the disease score value of the case generated in the second assessment cycle, so that disease
Score value can be adjusted according to the variation of currently practical medical conditions, improve the accuracy of disease score value.
The device that inventive embodiments are related to is described below.
It please refers to Fig. 4 and calculates equipment 40, including but not limited to: receiving unit 41, the first computing unit 42, second calculate single
Member 43, third computing unit 44 and adjustment unit 45 etc..Wherein,
Receiving unit 41, for receiving case collection, the case collection is that the first area generates within the first assessment cycle
Disease classification belongs to the set of the case of the first disease classification, and the case concentrates any one case to include at least practical medical insurance
Expense；
First computing unit 42, the basic disease score value for being classified according to first disease calculate in the case collection
The disease score value of each case；
Second computing unit 43, for calculating the case collection according to the disease score value of all cases in the case collection
First total medical insurance；
Third computing unit 44, for calculating the case according to the practical medical insurance of all cases in the case collection
Second total medical insurance of collection；
Adjustment unit 45, for according to described first total medical insurance and second total medical insurance adjustment described first
The first foundation disease score value of disease classification, first foundation disease score value adjusted is for calculating first area second
The disease generated in assessment cycle is classified as the disease score value of the case of the first disease classification.
In a kind of realization of the application, second assessment cycle is first assessment cycle or first assessment
Next assessment cycle in period.
In another realization of the application, first disease is classified as the item in disease classifying dictionary, the disease
Classifying dictionary includes the classification of multiple diseases and classifies one-to-one disease classification code with the multiple disease, the disease point
Class code is that ICD is encoded or the top N code of ICD coding, the N are the positive integer less than 6.
In another realization of the application, the case collection includes case i, the calculation formula of the disease score value of case i
Are as follows: Yi=A*Ci+Ei；
Wherein, i is the index that case concentrates case, and i is positive integer, YiFor the disease score value of case i, the case i is
Case in the first sub- case collection, A are the first foundation disease score value, CiFor the hospital-grade of hospital where the case i
Other coefficient, EiFor the additional disease score value of the case i.
Optionally, the calculation method of described first total medical insurance are as follows: S1=∑iYi*D；
The calculation method of second total medical insurance are as follows: S2=∑iTi
Wherein, S1For described first total medical insurance, D is score value unit price, S2For described second total medical insurance, TiFor institute
State the practical medical insurance of case i.
Equipment is calculated shown in referring to Fig. 5, which removes each shown in 40 including calculating equipment in Fig. 4
Outside unit, can also include, judging unit 46.Wherein,
Whether judging unit 46, the ratio for judging described first total medical insurance and second total medical insurance are big
In first threshold and it is less than second threshold, if it is, it is described according to described first total medical insurance to trigger the adjustment unit execution
Expense and second total medical insurance adjust the corresponding first foundation disease score value of the first disease classification.
Optionally, the adjustment unit 45 is specifically used for adjusting the first base of the first disease classification by following formula
Plinth disease score value includes:
A '=A* σ
Wherein, A ' is first foundation disease score value adjusted, and A is the first foundation disease score value, and σ is adjustment ginseng
Number, σ > 0.
Optionally, the adjusting parameter σ makes be calculated according to the first foundation disease score value adjusted
The ratio of three total medical insurances and second total medical insurance is greater than first threshold and is less than second threshold.
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:
Case collection is received by the communication module 616, the case collection is that the first area produces within the first assessment cycle
Raw disease classification belongs to the set of the case of the first disease classification, and it is practical that the case concentrates any one case to include at least
Medical insurance；
The disease point of each case in the case collection is calculated according to the basic disease score value that first disease is classified
Value；
First total medical insurance of the case collection, and root are calculated according to the disease score value of all cases in the case collection
Second total medical insurance of the case collection is calculated according to the practical medical insurance of all cases in the case collection；
The first of the first disease classification is adjusted according to described first total medical insurance and second total medical insurance
Basic disease score value, first foundation disease score value adjusted generate within the second assessment cycle for calculating first area
Disease be classified as first disease classification case disease score value.
In a kind of realization of the application, second assessment cycle is first assessment cycle or first assessment
Next assessment cycle in period.
In another realization of the application, first disease is classified as the item in disease classifying dictionary, the disease
Classifying dictionary includes the classification of multiple diseases and classifies one-to-one disease classification code with the multiple disease, the disease point
Class code is that ICD is encoded or the top N code of ICD coding, the N are the positive integer less than 6.
In another realization of the application, the case collection includes case i, the calculation formula of the disease score value of case i
Are as follows: Yi=A*Ci+Ei；
Wherein, i is the index that case concentrates case, and i is positive integer, YiFor the disease score value of case i, the case i is
Case in the first sub- case collection, A are the first foundation disease score value, CiFor the hospital-grade of hospital where the case i
Other coefficient, EiFor the additional disease score value of the case i.
Optionally, the calculation method of described first total medical insurance are as follows: S1=∑iYi*D；
The calculation method of second total medical insurance are as follows: S2=∑iTi
Wherein, S1For described first total medical insurance, D is score value unit price, S2For described second total medical insurance, TiFor institute
State the practical medical insurance of case i.
In another realization of the application, the processor 611 execute it is described according to described first total medical insurance and
Before second total medical insurance adjusts the first foundation disease score value of the first disease classification, the processor 611 is also
For executing:
Judge whether the ratio of described first total medical insurance and second total medical insurance is greater than first threshold and small
In second threshold, if it is, trigger the processor 611 execute it is described according to described first total medical insurance and described second
Total medical insurance adjusts the step of the first disease classification corresponding first foundation disease score value.
Optionally, the processor 611 executes described according to described first total medical insurance and second total medical insurance expense
Include: with the first foundation disease score value for adjusting the first disease classification
A '=A* σ
Wherein, A ' is first foundation disease score value adjusted, and A is the first foundation disease score value, and σ is adjustment ginseng
Number, σ > 0.
Optionally, the adjusting parameter σ makes be calculated according to the first foundation disease score value adjusted
The ratio of three total medical insurances and second total medical insurance is greater than first threshold and is less than second threshold.
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 500 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 method of adjustment based on big data characterized by comprising
It calculates equipment and receives case collection, the case collection is that the disease classification that the first area generates within the first assessment cycle belongs to
The set of the case of first disease classification, the case concentrate any one case to include at least practical medical insurance；
The calculating equipment calculates each case in the case collection according to the basic disease score value that first disease is classified
Disease score value；
The first total medical insurance for calculating equipment and calculating the case collection according to the disease score value of all cases in the case collection
Expense, and calculate according to the practical medical insurance of all cases in the case collection second total medical insurance of the case collection；
The calculating equipment adjusts first disease point according to described first total medical insurance and second total medical insurance
The first foundation disease score value of class, first foundation disease score value adjusted is for calculating first area in the second assessment week
The disease generated in phase is classified as the disease score value of the case of the first disease classification.
2. the method as described in claim 1, which is characterized in that second assessment cycle is first assessment cycle or institute
State next assessment cycle of the first assessment cycle.
3. the method as described in claim 1, which is characterized in that the case collection includes case i, the disease score value of case i
Calculation formula are as follows: Yi=A*Ci+Ei；
Wherein, i is the index that the case concentrates case, and i is positive integer, YiFor the disease score value of case i, the case i is institute
Case in case collection is stated, A is the first foundation disease score value, CiFor the hospital grade coefficient of hospital where the case i, Ei
For the additional disease score value of the case i.
4. method as claimed in claim 3, which is characterized in that the calculation method of first total medical insurance are as follows: S1=∑iYi*D；
The calculation method of second total medical insurance are as follows: S2=∑iTi
Wherein, S1For described first total medical insurance, D is score value unit price, S2For described second total medical insurance, TiFor the disease
The practical medical insurance of example i.
5. method according to any of claims 1-4, which is characterized in that the calculating equipment is according to described first total medical insurance
Before expense and second total medical insurance adjust the first foundation disease score value of the first disease classification, the method is also
Include:
Judge whether the ratio of described first total medical insurance and second total medical insurance is greater than first threshold and less than
Two threshold values are always cured according to described first total medical insurance with described second if it is, the triggering calculating equipment execution is described
Premium adjusts the step of the first disease classification corresponding first foundation disease score value.
6. method as claimed in claim 5, which is characterized in that the calculating equipment is according to described first total medical insurance and institute
It states second total medical insurance and adjusts the first foundation disease score value of first disease classification and include:
A '=A* σ
Wherein, A ' is first foundation disease score value adjusted, and A is the first foundation disease score value, and σ is adjusting parameter, σ >
0。
7. method as claimed in claim 6, which is characterized in that the adjusting parameter σ makes according to described adjusted first
The ratio of the total medical insurance of third and second total medical insurance that basic disease score value is calculated be greater than first threshold and
Less than second threshold.
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 method of adjustment described in any one of 1-7 claim based on big data.
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 method of adjustment based on big data.
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 method of adjustment based on big data.
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