WO2020078058A1 - Medical data abnormality identification method and device, terminal, and storage medium - Google Patents

Medical data abnormality identification method and device, terminal, and storage medium Download PDF

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Publication number
WO2020078058A1
WO2020078058A1 PCT/CN2019/096631 CN2019096631W WO2020078058A1 WO 2020078058 A1 WO2020078058 A1 WO 2020078058A1 CN 2019096631 W CN2019096631 W CN 2019096631W WO 2020078058 A1 WO2020078058 A1 WO 2020078058A1
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medical data
preset
disease type
abnormality
days
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PCT/CN2019/096631
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French (fr)
Chinese (zh)
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周竹凌
汪丽娟
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平安医疗健康管理股份有限公司
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Publication of WO2020078058A1 publication Critical patent/WO2020078058A1/en

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    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/06Asset management; Financial planning or analysis
    • GPHYSICS
    • G16INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16HHEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/70ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for mining of medical data, e.g. analysing previous cases of other patients

Definitions

  • the present application relates to the technical field of medical data processing, and in particular, to a method, device, terminal, and computer-readable storage medium for identifying abnormal medical data.
  • the medical insurance system is a kind of social compulsory insurance for the state to prevent and share the medical expenses caused by diseases.
  • the expenses are jointly paid by the employer and the individual, and the medical insurance money is paid by the medical insurance institution to solve the laborers ’illness or illness. Medical risks from injury.
  • the medical insurance department will evaluate the hospital.
  • the number of single hospital stays is an important evaluation index of the hospital's medical efficiency.
  • the main purpose of the present application is to provide a method for identifying abnormal medical data, aiming to solve the technical problem that the medical insurance card behavior data cannot be detected abnormally.
  • the present application provides a medical data abnormality identification method, characterized in that the medical data abnormality identification method includes the following steps:
  • the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained;
  • the target medical data is marked abnormally.
  • the present application also provides a medical data abnormality identification device
  • the medical data abnormality identification device includes:
  • An obtaining module configured to obtain the target hospital corresponding to the abnormal detection request and the medical data to be detected of the target hospital when the abnormal detection request is detected;
  • a grouping module configured to group the medical data to be detected according to a preset dimension to obtain a grouped subset
  • An anomaly analysis module configured to analyze each of the subsets based on a preset rule corresponding to a preset dimension, and determine whether there is target medical data satisfying an abnormal feature in the medical data to be detected;
  • the abnormal marking module is configured to mark the target medical data abnormally if there is target medical data satisfying abnormal characteristics in the medical data to be detected.
  • the present application also provides a medical data abnormality identification terminal
  • the medical data abnormality identification terminal includes a processor, a memory, and a computer stored on the memory and executable by the processor. Read instructions, where the computer-readable instructions are executed by the processor to implement the steps of the medical data abnormality identification method as described above.
  • the present application also provides a computer-readable storage medium having computer-readable instructions stored on the computer-readable storage medium, wherein when the computer-readable instructions are executed by a processor, the implementation is as described above Steps of the method for identifying abnormal medical data.
  • FIG. 1 is a schematic structural diagram of a medical data abnormality recognition terminal in a hardware operating environment involved in an embodiment of the present application
  • FIG. 2 is a schematic flowchart of a first embodiment of a medical data abnormality identification method of the application
  • FIG. 3 is a schematic flowchart of a second embodiment of a medical data abnormality identification method of the present application.
  • FIG. 4 is a schematic flowchart of a fifth embodiment of a medical data abnormality identification method of the present application.
  • FIG. 5 is a schematic diagram of functional modules of the first embodiment of the medical data abnormality recognition device of the present application.
  • FIG. 1 is a schematic diagram of the hardware structure of the medical data abnormality identification terminal provided by the present application.
  • the medical data abnormality identification terminal may be a PC or a device terminal with a display function such as a smart phone, tablet computer, portable computer, desktop computer, etc.
  • the medical data abnormality identification terminal may be a server device that exists A back-end management system for medical data abnormality identification, and a user manages the medical data abnormality identification terminal through the back-end management system.
  • the medical data abnormality identification terminal may include components such as a processor 101 and a memory 201.
  • the processor 101 is connected to the memory 201, and the memory 201 stores computer-readable instructions, and the processor 101 can call the computer-readable instructions stored in the memory 201, and The steps of each embodiment of the medical data abnormality recognition method described below are implemented.
  • the memory 201 can be used to store software computer readable instructions and various data.
  • the memory 201 may mainly include an area for storing computer-readable instructions and an area for storing data.
  • the memory 201 may include a high-speed random access memory, and may also include a non-volatile memory, such as at least one magnetic disk storage device, a flash memory device, or other volatile solid-state storage devices.
  • the processor 101 is the control center of the medical data abnormality recognition terminal, and uses various interfaces and lines to connect the various parts of the entire medical data abnormality recognition terminal, by running or executing software computer readable instructions and / or modules stored in the memory 201 , And call the data stored in the memory 201 to perform various functions and process data of the medical data abnormality recognition terminal, thereby performing overall monitoring of the medical data abnormality recognition terminal.
  • the processor 101 may include one or more processing units; optionally, the processor 101 may integrate an application processor and a modem processor, where the application processor mainly processes an operating system, a user interface, and application computer-readable instructions, etc.
  • the modem processor mainly handles wireless communication. It can be understood that the foregoing modem processor may not be integrated into the processor 101.
  • the structure of the medical data abnormality identification terminal shown in FIG. 1 does not constitute a limitation on the medical data abnormality identification terminal, and may include more or less components than the illustration, or a combination of certain components, Or different component arrangements.
  • the identification terminal in the following is an abbreviation of a medical data abnormality identification terminal.
  • This application provides a method for identifying abnormal medical data.
  • FIG. 2 is a schematic flowchart of a first embodiment of a medical data abnormality recognition method of this application.
  • the medical data abnormality identification method includes the following steps:
  • Step S10 when an abnormality detection request is detected, the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained;
  • the anomaly detection request is an instruction that triggers the start of the computer-readable instruction corresponding to the medical data anomaly detection method of the present application.
  • the anomaly detection request can be triggered by a preset external event / page request, such as a click operation for anomaly detection input by a user; it can also be passed Use the timed JOB (task) method as the starting interface for computer-readable instructions, which triggers anomaly detection of medical data at regular intervals. It can also perform anomaly detection immediately after receiving medical data to be detected. Anomaly detection is performed after the amount of medical data to be detected reaches a certain threshold.
  • the anomaly detection of medical data in this application may be one or more process nodes in the medical data review process, and the abnormality detection of medical data may be automatically triggered by the flow of the process nodes.
  • the medical data of the target hospital to be detected is used as the basis for abnormal identification.
  • the anomaly detection request contains the identification of the corresponding target hospital.
  • the medical data to be detected is the specific medical data pointed to by the abnormal detection request and the target hospital requested for detection.
  • the medical data includes but is not limited to: type of treatment, identification of treatment items, time of treatment, diagnosis results, medication situation, amount of treatment, amount of medication Wait.
  • the card swiping device After the insured person swipes the medical insurance card, the card swiping device will upload the relevant medical data to the hospital terminal, and then the hospital terminal sends it to the identification terminal or directly uploads it to the identification terminal, which can be directly stored in the memory of the identification terminal, when performing abnormal detection ,
  • the identification terminal directly obtains the medical data to be detected from the local storage according to the abnormal detection request, or it can be stored in the data storage terminal / cloud of the medical data, so that the identification terminal can detect the abnormal medical data from the data according to the abnormal detection request
  • the storage terminal / cloud obtains medical data to be tested.
  • Step S20 Group the medical data to be detected according to a preset dimension to obtain a grouped subset
  • the preset dimension includes at least one of the hospital dimension and the personal dimension.
  • the hospital dimension is based on the analysis of all medical data of the target hospital to determine whether there is abnormal medical data
  • the personal dimension is based on the medical data analysis of each participant to determine whether there is abnormal medical data .
  • Each preset dimension can be set as a clickable control, and the preset dimension for analysis selected by the user can be determined according to the user's click operation, or the default preset dimension can be directly obtained.
  • the preset dimensions are different, and the medical data to be tested are grouped in different ways.
  • the identification terminal groups the medical data to be tested according to the disease type, and a corresponding subset of each disease type can be obtained;
  • the preset dimension is an individual, the identification terminal groups the medical data to be tested according to the insured person By grouping, you can get a subset of each insured person.
  • the identification terminal may simultaneously and separately analyze the medical data to be detected according to the hospital dimension and the individual dimension to identify abnormal data.
  • Step S30 Analyze each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected;
  • Each preset dimension has its own corresponding preset rule, and each subset is the analysis object of the preset rule.
  • the preset dimension is a hospital dimension
  • the medical data to be tested are grouped according to disease types to obtain a first subset corresponding to each disease type, based on the Calculate the average number of single hospitalization days corresponding to each disease type, and / or average number of hospitalizations per person, and / or average amount of single hospitalization, and calculate the average number of single hospitalization days corresponding to each disease type, and / or per person
  • the average number of hospitalizations, and / or the average single hospitalization amount are compared with preset values corresponding to each disease type, and it is determined whether the first subset corresponding to each disease type meets the abnormal feature.
  • Abnormal characteristics refer to the characteristics set in advance to limit abnormal medical data. For example, the average number of days of hospitalization corresponding to each disease type is compared with the preset value corresponding to each type of disease. The number of hospitalization days is greater than the preset value corresponding to each disease type, then the first subset corresponding to the disease type meets the abnormal characteristics.
  • Step S40 if there is target medical data satisfying abnormal characteristics in the medical data to be detected, the target medical data is marked abnormally.
  • the target medical data is marked abnormally, and the abnormal detection result is output to prompt the user to perform offline verification. If there is no abnormal target medical data in the medical data to be detected, it is prompted that there is no abnormality.
  • the abnormality so as to identify the terminal and / or the user to select the corresponding processing method for the target medical data to process, and obtain the abnormal type of the target medical data; according to the abnormal type, obtain the corresponding abnormality identifier to detect medical treatment
  • the data is marked abnormally. Further, when the correction instruction input after the offline verification by the user is detected, the state of the target medical data is modified to be normal.
  • the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained; the medical data to be detected are grouped according to a preset dimension to obtain the grouped Sub-sets; analyze each of the sub-sets based on preset rules corresponding to preset dimensions to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be tested; For target medical data, the target medical data is abnormally marked.
  • the medical data to be tested of the target hospital can be obtained, and the target hospital can be targeted to analyze and identify whether the target hospital violates the medical insurance regulations; Grouped analysis can effectively detect abnormal medical data; mark abnormal medical target data that meets abnormal characteristics in the medical data to be detected, and distinguish the abnormal medical data for subsequent targeted treatment of abnormal medical data to standardize medical treatment The normal operation of the expense reimbursement system.
  • the step S20 includes:
  • Step S21 Group the medical data to be tested according to the disease type, and obtain a first sub-set corresponding to each disease type;
  • Disease types including primary diagnosis (such as diabetes) and secondary diagnosis / complication (kidney disease, fundus disease, neuropathy, etc.), when grouping, according to the primary diagnosis + secondary diagnosis, that is, the medical data is grouped according to the breakdown .
  • primary diagnosis such as diabetes
  • secondary diagnosis / complication kidney disease, fundus disease, neuropathy, etc.
  • the step S30 includes:
  • Step S310 Obtain the total number of hospitalizations and the total number of hospitalization days of each disease type from the first subset corresponding to each disease type, and calculate and obtain the average number of each disease type based on the total number of hospitalizations and the total number of hospitalization days Number of hospital stays;
  • the average number of hospital days per disease refers to the average number of hospital days for a disease.
  • the average number of hospital stays for different diseases is different. Therefore, the average number of hospital stays for each disease is calculated based on the first subset corresponding to each disease.
  • the medical data of a single hospitalization day above / below the first preset value can be marked in the first subset corresponding to the disease type Come out and further verify, and at the same time, calculate the average number of days of hospitalization for the disease based on the remaining medical data.
  • the number of hospitalization days is mostly between 4-10 days, but once the hospitalization was 2 days and once the hospitalization was 14 days, the two abnormal data were marked for further verification, and the These two abnormal data are eliminated, and the average number of hospital stays is calculated based on the remaining 18 data.
  • Step S311 Compare the average number of hospitalization days of each disease type with the preset days corresponding to each disease type, obtain the difference between the average number of hospitalization days of each disease type and the corresponding preset days, and calculate each disease type The ratio of the difference in the number of days to the corresponding preset number of days to obtain the abnormal factor for the number of days corresponding to each disease type;
  • the preset number of days is calculated based on the average number of hospital stays in the same class and the same type of disease in the same type of medical institutions that have been reviewed.
  • the same level refers to the general hospital grades such as "Third Class A Hospital” and "Second Class A Hospital”, and the category refers to the same specialty. For example, they belong to the specialty of children, and the same disease includes the main diagnosis and the auxiliary diagnosis.
  • the preset number of days can be a range.
  • the abnormal number of days refers to the parameter used to identify the abnormal degree of the average number of days in a single hospital stay.
  • the ratio of the difference between the average number of days of hospitalization for each disease type and the number of days corresponding to the preset number of days and the number of days corresponding to the preset number of days is used as the abnormal factor for the number of days corresponding to each disease type. For example, if the preset number of days for diabetes complicated with lactic acidosis is 15 days, and the average number of single hospital stays in the target hospital is 7 days, the difference is 8 days, then it is calculated based on the preset days, average number of single hospital stays, and the difference in days Days anomaly factor, the days anomaly factor in the above example is (15-7) / 15.
  • the number of days abnormal factor When the number of days abnormal factor is 0, that is, the difference between the average number of days of single hospitalization and the corresponding preset days is 0, indicating that the average number of days of corresponding single hospitalization of the corresponding disease is not abnormal; when the number of days abnormal factor ⁇ 0, it is the average single The number of hospitalization days is greater than the corresponding preset number of days, indicating that there can be no decomposition hospitalization for the corresponding disease, that is, the average number of single hospitalization days is not abnormal; when the abnormality factor of the number of days> 0, the average number of single hospitalization days is less than the corresponding preset number of days, indicating that the corresponding disease The average number of hospitalization days for each species is abnormal, and the value indicates the degree of abnormality.
  • Step S312 when the abnormal number of days corresponding to any disease type is greater than the first preset threshold, the first subset corresponding to the disease type satisfies the abnormal characteristics.
  • the first preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
  • the abnormal score of the target hospital may be calculated according to the abnormal number of days corresponding to each disease type.
  • the abnormal number of days corresponding to each disease type is integrated to calculate the abnormal score of the target hospital.
  • the sum of all the abnormal factors of the number of days can be used as the abnormal score of the target hospital.
  • the degree of instability of the disease (a disease with a large individual difference) is assigned a reference value, and the sum of the product of the reference value corresponding to each disease and the abnormal number of days is used as the abnormal score of the target hospital.
  • the average number of single hospitalization days of each disease type is obtained by calculation, and the average number of single hospitalization days of each disease type of the target hospital is compared with the average number of single hospitalization days of the same disease type and medical institution of the same class (ie Preset days) to compare, identify the medical data in the target hospital's medical data that does not meet the usual situation, and characterize the degree of abnormality by the number of days abnormal factor, when the number of days abnormal factor is greater than the first preset threshold, the corresponding disease type
  • the first sub-set is determined to satisfy the abnormal features and realize the identification of abnormal medical data.
  • the step S30 includes:
  • Step S313 Obtain the number of insured persons and the total number of hospitalizations of each disease type from the first subset corresponding to each disease type, and calculate the average per capita corresponding to each disease type based on the number of insured persons of each disease type and the total number of hospitalizations Number of hospitalizations;
  • the first subset corresponding to each disease type contains all medical data corresponding to each disease type in the target hospital. From the first subset corresponding to each disease type, the number of insured persons corresponding to each disease type and the total number of hospitalizations are counted. The average number of hospitalizations per person can be obtained by dividing the total number of hospitalizations by the number of insured persons. For example, if diabetes is complicated by lactic acidosis, the total number of hospitalizations is 100, and the number of insured persons is 14, then the average number of hospitalizations per person for this disease is 100/14.
  • Step S314 Compare the average number of hospitalizations per person for each disease type with the corresponding preset number of times, obtain the difference between the number of average hospitalizations per person for each disease type and the corresponding preset number of times, and calculate the number of times for each disease type The ratio of the difference to the corresponding preset number of times to obtain the abnormal factor of the number of times corresponding to each disease type;
  • the preset number of times is calculated based on the average number of hospitalizations of the same diagnosis (primary diagnosis / subdiagnosis) of the same disease in the same level and the same category of medical institutions under review.
  • the number of abnormal factors refers to the parameter used to identify the abnormal degree of the average number of hospitalizations per person.
  • the frequency anomaly factor in the above example is (17-10) / 10.
  • the number of abnormal factors When the number of abnormal factors is 0, that is, the difference between the average number of hospitalizations per person and the corresponding preset number of times is 0, indicating that the average number of hospitalizations per person for the corresponding disease type is not abnormal; when the number of abnormal factors ⁇ 0, the average The number of hospitalizations is less than the corresponding preset number, indicating that there can be no decomposition hospitalization for the corresponding disease, that is, the average number of hospitalizations per person is not abnormal; when the number of abnormal factors is> 0, the average number of hospitalizations per person is greater than the corresponding preset number, indicating the corresponding disease
  • the average number of hospitalizations per person for each species is abnormal, and the value indicates the degree of abnormality. The larger the value, the greater the degree of abnormality.
  • Step S315 when the abnormality factor of the number of times corresponding to any disease type is greater than the second preset threshold, the first subset corresponding to the disease type satisfies the abnormal characteristics.
  • the second preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
  • the abnormal score of the target hospital may be calculated according to the abnormal factor of the number of times corresponding to each disease type.
  • the abnormal factors of the number of times corresponding to each disease are integrated to calculate the abnormal score of the target hospital.
  • the sum of all the abnormal factors of the number of times can be used as the abnormal score of the target hospital;
  • the degree of instability of the disease type (the disease type with large individual difference) is assigned a reference value, and the sum of the product of the reference value corresponding to each disease type and the number of abnormal factors is used as the abnormal score of the target hospital;
  • the abnormal number of days and the abnormal number of times are combined to calculate the overall abnormal score of the target hospital, with more participation dimensions and more accurate abnormal scores.
  • the average number of hospitalizations per person of each disease type is obtained by calculation, and the average number of hospitalizations per person of each disease type in the target hospital is compared with the average number of hospitalizations per person of the same disease type and medical institution of the same class (ie Preset times) to compare, identify the medical data in the target hospital's medical data that does not meet the usual situation, and characterize the degree of abnormality by the number of times abnormal factor, when the number of times abnormal factor is greater than the second preset threshold, the corresponding disease type
  • the first sub-set is determined to satisfy the abnormal features and realize the identification of abnormal medical data.
  • the step S30 includes:
  • Step S316 Obtain the total number of hospitalizations and total hospitalization amount of each disease type from the first subset corresponding to each disease type, and calculate and obtain the average bill of each disease type based on the total number of hospitalizations and total hospitalization amount of each disease type Amount of second hospitalization;
  • the average amount of single hospitalization for each disease refers to the average amount of single hospitalization for a certain disease.
  • the average single hospitalization amount for different diseases is different. Therefore, the average single hospitalization amount for each disease type is calculated based on the first subset corresponding to each disease type.
  • the medical data of a single hospitalization amount higher / lower than the first preset value may be marked in the first subset corresponding to the disease type Come out and further verify, at the same time, calculate the average single hospitalization amount of the disease based on the remaining medical data.
  • Step S317 compare the average single hospitalization amount of each disease type with the corresponding preset amount, obtain the difference between the average single hospitalization amount of each disease type and the corresponding preset amount, and calculate the The ratio of the amount difference to the corresponding preset amount to obtain the amount abnormality factor corresponding to each disease type;
  • the preset amount is calculated based on the average single hospitalization amount of the same class and the same disease in the medical institutions of the same class that have been reviewed. For example, they belong to the specialty of children, and the same disease includes the main diagnosis and the auxiliary diagnosis.
  • the preset amount can be a range of values.
  • the amount abnormality factor refers to the parameter used to identify the abnormal degree of the average single hospitalization amount.
  • the ratio of the difference between the average single hospitalization amount of each disease type and the corresponding preset amount and the corresponding preset amount is used as the amount abnormality factor corresponding to each disease type. For example, if the preset amount of diabetes complicated with lactic acidosis is 10,000 yuan / time, and the average single hospitalization amount of the target hospital is 5,000 yuan / time, the difference is 5000 yuan / time, according to the preset amount, the average single The hospitalization amount and the amount difference are calculated as the amount abnormality factor.
  • the amount abnormality factor in the above example is (10000-5000) / 10000. If the average amount of a single hospitalization is relatively small, it may be shared with another hospitalization, that is, there may be decomposition of hospitalization.
  • the amount abnormality factor ⁇ 1 it means there is an abnormality. The smaller the value, the greater the degree of abnormality.
  • the third preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
  • the abnormal score of the target hospital may be calculated according to the amount abnormality factor corresponding to each disease type.
  • the abnormal amount of money corresponding to each disease type is integrated to calculate the abnormal score of the target hospital.
  • the sum of all abnormal amounts of money can be used as the abnormal score of the target hospital;
  • the degree of instability of the disease type (the disease with large individual difference) is assigned a reference value, and the sum of the product of the reference value corresponding to each disease type and the amount abnormality factor is used as the abnormal score of the target hospital; it can also be based on the amount abnormality factor and the number of days
  • the abnormal factor and the frequency abnormal factor calculate the abnormal score of the target hospital.
  • the average single hospitalization amount of each disease type is obtained by calculation, and the average single hospitalization amount of each disease type of the target hospital is compared with the average single hospitalization amount of the same type and type of medical institution (ie. Preset amount) to compare, identify the medical data in the target hospital's medical data that does not meet the usual situation, and characterize the degree of abnormality by the amount abnormality factor, when the amount abnormality factor is greater than the third preset threshold, the corresponding disease type
  • the first sub-set is determined to satisfy the abnormal features and realize the identification of abnormal medical data.
  • the step S20 includes:
  • Step S22 Group the medical data to be tested according to the insured persons to obtain a second subset corresponding to each insured person;
  • the medical data set to be tested corresponding to each insured person is the second subset.
  • the step S30 includes:
  • Step S320 extracting the consultation time corresponding to each piece of medical data in the second sub-collection, and calculating the interval between adjacent consultations to obtain the adjacent medical data in the second sub-collection;
  • the identification terminal can obtain the visit time of each visit from the medical data, wherein each visit generates a corresponding piece of medical data, which is arranged in order of the visit time, and then calculates the adjacent visit interval for arranging the adjacent medical data.
  • the identification terminal obtains the adjacent visit intervals of all adjacent medical data in the second subset; in another embodiment, the second subset is regrouped according to the disease type to obtain the third subset, and the third Each piece of medical data in the three sub-collections is arranged according to the order of visit time, and the adjacent visit interval of the adjacent hospital visits of the same disease type is calculated.
  • Step S321 Obtain a preset time interval threshold, calculate a time difference between the adjacent consultation interval and the time interval threshold, calculate a ratio of the time difference to the time interval threshold, and obtain each item in the second subset The interval anomaly factor corresponding to medical data;
  • the recognition terminal may calculate the difference between the adjacent visit interval and the time interval threshold, and determine the interval anomaly factor corresponding to each piece of medical data according to the difference.
  • the adjacent visit interval is less than the time interval threshold, the two The greater the difference is, the greater the interval anomaly factor.
  • the adjacent visit interval is greater than or equal to the time interval threshold, the greater the difference between the two, the smaller the interval anomaly factor.
  • each piece of medical data corresponds to at least one interval anomaly factor, for example, [1, 2], [2, 3], etc., where the number refers to a single parameter
  • the serial number of the insured ’s hospitalization times is arranged in chronological order.
  • interval anomaly factors which are the interval anomaly factor and the second hospitalization for the second hospitalization and the first hospitalization, respectively.
  • Step S322 when the interval abnormality factor corresponding to the medical data in the second subset is greater than the fourth preset threshold, the medical data meets the abnormality feature.
  • the fourth preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
  • the neighboring visit interval of the neighboring medical data in the second subset is calculated; the preset time interval threshold is obtained, and the The time difference between the adjacent visit interval and the time interval threshold, calculating the ratio of the time difference to the time interval threshold to obtain the interval anomaly factor corresponding to each piece of medical data in the second subset; in the second
  • the interval anomaly factor corresponding to the medical data in the subset is greater than the fourth preset threshold, the medical data meets the anomaly characteristics, because for the same insured person, if the interval between adjacent hospitalizations is too short, there may be decomposition hospitalization Suspected, by calculating the adjacent medical interval of adjacent medical data, and screening out the medical data with a large degree of suspiciousness based on the interval abnormality factor corresponding to each medical data, it can accurately determine whether the medical data contains suspicious decomposition of hospitalization behavior, effective Prevent fraudulent behavior and reduce loss of public interest.
  • step after the step S321 includes:
  • Step S323 Extract the diagnosis result corresponding to each piece of medical data in the second subset, and determine whether there is adjacent medical data corresponding to a similar diagnosis result in the second subset;
  • the diagnosis result refers to the doctor's judgment on the cause of the insured person's illness.
  • the diagnosis is diabetic complicated with lactic acidosis.
  • the diagnosis result includes the main diagnosis and the auxiliary diagnosis.
  • the similar diagnosis results in this embodiment include the same diagnosis results and similar diagnosis results.
  • a diagnosis result database can be established in advance, and the same diagnosis results and similar diagnosis results with different names can be stored in the diagnosis result database to determine the diagnosis of adjacent medical data. When the result is similar to the diagnosis result, it can be judged by querying the diagnosis result database.
  • Step S323 if there is adjacent medical data corresponding to a similar diagnosis result in the second subset, the time difference between the adjacent visit interval of the adjacent medical data and the time interval threshold is obtained, and the time difference and The ratio of the time interval threshold to obtain the interval anomaly factor corresponding to the adjacent medical data;
  • the interval anomaly factor determines whether the two or more adjacent medical data have an abnormal time (if there is an abnormality, the size of the abnormality).
  • Step S324 when the interval anomaly factor corresponding to the adjacent medical data is greater than the fifth preset threshold, the medical data meets the anomaly characteristics.
  • the interval anomaly factor corresponding to the adjacent medical data is greater than the fifth preset threshold, the possibility that the adjacent medical data is decomposed into inpatient medical data is further increased. Because if the medical treatment interval corresponding to the adjacent medical data is small and the diagnosis results are the same or similar, the adjacent medical data is likely to be the data for decomposing hospitalization.
  • the step S30 includes:
  • Step S325 Extract the diagnosis and treatment items corresponding to each piece of medical data in the second sub-collection, and compare the diagnosis and treatment items corresponding to each adjacent consultation with the reference diagnosis and treatment item set respectively to obtain the corresponding diagnosis and treatment items and reference diagnosis and treatment for each adjacent treatment The coincidence ratio of the item set, and calculate the average coincidence ratio of all adjacent visits to obtain the continuity of the adjacent treatment items;
  • the identification terminal After the identification terminal arranges each inpatient consultation according to the time sequence of the consultation, it can obtain the identification of the treatment items included in the adjacent inpatient consultations, and compare the corresponding treatment items of the adjacent consultations with the reference set of treatment items, Obtain the coincidence ratio of the corresponding treatment items of the adjacent consultations and the set of reference treatment items, and calculate the average coincidence ratio of all the adjacent consultations to obtain the continuity of the treatment items of the adjacent consultations.
  • a database of diagnosis and treatment specifications corresponding to various diagnosis results can be established in advance, including the diagnosis and treatment items (identification) corresponding to each diagnosis result. Because the treatment of a disease often follows a certain clinical / treatment path, therefore, the corresponding diagnosis results The diagnosis and treatment items are arranged in sequence based on a certain clinical / treatment path.
  • the diagnosis and treatment items are in the reference diagnosis and treatment item set, specifically: the diagnosis and treatment items in the reference diagnosis and treatment item set account for the proportion of the adjacent diagnosis and treatment items, and the average coincidence ratio of all adjacent visits is calculated, and the average coincidence ratio is that of the adjacent consultations Continuity of diagnosis and treatment items.
  • the nth visit is the n + 1 visit as a neighboring visit
  • the nth visit is A, B, C
  • the n + 1 visit is D, E, F, G, H
  • the reference diagnosis and treatment item set is [A, B, C, D, E, F, G]
  • the coincidence ratio of the diagnosis and treatment items corresponding to the nth visit and the reference diagnosis and treatment item set is 100%, corresponding to the n + 1th visit
  • Step S326 when the continuity is greater than the sixth preset threshold, the corresponding medical data meets abnormal characteristics.
  • the sixth preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
  • the sixth preset threshold may be 45%.
  • step S325 in this embodiment it may further include a judgment based on the similarity between the adjacent medical intervals of the adjacent medical data and the diagnosis results, specifically including:
  • the interval between adjacent visits based on adjacent medical data, the similarity of diagnosis results, and the continuity of the diagnosis and treatment items of adjacent visits can improve the accuracy of identifying abnormal medical data, reduce false positives, and increase the flexibility of abnormal detection.
  • the corresponding medical data satisfies the abnormal characteristics, and the judgment on the decomposition of the hospitalization behavior can be realized based on the clinical treatment path, which is effective Prevent fraudulent behavior and reduce loss of public interest.
  • the present application also provides a medical data abnormality recognition device corresponding to each step of the foregoing medical data abnormality recognition method.
  • FIG. 5 is a schematic diagram of functional modules of the first embodiment of the medical data abnormality recognition device of the present application.
  • the medical data abnormality identification device of the present application includes:
  • the obtaining module 10 is configured to obtain the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital when the abnormality detection request is detected;
  • a grouping module 20 configured to group the medical data to be detected according to a preset dimension to obtain a grouped subset
  • An anomaly analysis module 30 configured to analyze each of the subsets based on a preset rule corresponding to a preset dimension, and determine whether there is target medical data satisfying anomalous characteristics in the medical data to be detected;
  • the abnormal marking module 40 is configured to mark the target medical data abnormally if there is target medical data satisfying abnormal characteristics in the medical data to be detected.
  • the medical data abnormality identification device includes:
  • the grouping module 20 is further configured to group the medical data to be tested according to the disease type when the preset dimension is the hospital dimension, to obtain a first subset corresponding to each disease type;
  • the first calculation module is used to obtain the total number of hospitalizations and the total number of hospitalization days of each disease type from the first subset corresponding to each disease type, and calculate and obtain each disease based on the total number of hospitalizations and the total number of hospitalization days of each disease type The average number of hospital stays per species; compare the average number of hospital stays for each disease with the preset days corresponding to each disease to obtain the difference between the average number of hospital stays for each disease and the number of days corresponding to the preset days , Calculate the ratio of the difference between the number of days of each disease type and the corresponding preset number of days to obtain the abnormal factor of the number of days corresponding to each disease type;
  • the first abnormality determination module is configured to: when the abnormality factor of the number of days corresponding to any disease type is greater than the first preset threshold, the first subset corresponding to the disease type meets the abnormality feature.
  • the medical data abnormality identification device includes:
  • the second calculation module is used to obtain the number of insured persons and the total number of hospitalizations of each disease type from the first sub-collection corresponding to each disease type, and calculate and obtain the correspondence of each disease type based on the number of insured persons of each disease type and the total number of hospitalizations
  • the average number of hospitalizations per person for each patient compare the average number of hospitalizations per person for each disease type with the corresponding preset number of times to obtain the difference between the average number of hospitalizations per person for each disease type and the corresponding preset number of times to calculate each disease type
  • the second abnormality determination module is configured to: when the abnormality factor of the number of times corresponding to any disease type is greater than the second preset threshold, the first subset corresponding to the disease type satisfies abnormal characteristics.
  • the medical data abnormality identification device includes:
  • the third calculation module is used to obtain the total number of hospitalizations and total hospitalization amount of each disease type from the first subset corresponding to each disease type, and calculate and obtain each disease based on the total number of hospitalizations and total hospitalization amount of each disease type
  • the average single hospitalization amount of each kind compare the average single hospitalization amount of each disease with the corresponding preset amount to obtain the difference between the average single hospitalization amount of each disease and the corresponding preset amount, and calculate each The ratio of the amount difference of the disease type to the corresponding preset amount to obtain the amount abnormality factor corresponding to each disease type;
  • the third abnormality determination module is configured to: when the amount abnormality factor corresponding to any disease type is greater than the third preset threshold, the first subset corresponding to the disease type meets abnormal characteristics.
  • the medical data abnormality identification device includes:
  • the grouping module 20 is further configured to group the medical data to be tested according to the insured persons when the preset dimension is an individual dimension to obtain a second subset corresponding to each insured person;
  • the fourth calculation module is used for extracting the consultation time corresponding to each piece of medical data in the second subset, calculating the adjacent consultation interval for obtaining the adjacent medical data in the second subset; obtaining the preset time interval threshold Calculate the time difference between the adjacent consultation interval and the time interval threshold, calculate the ratio of the time difference and the time interval threshold to obtain the interval abnormality factor corresponding to each piece of medical data in the second subset;
  • the fourth abnormality determination module is configured to: when the interval abnormality factor corresponding to the medical data in the second subset is greater than the fourth preset threshold, the medical data meets the abnormality feature.
  • the medical data abnormality identification device includes:
  • the similarity judgment module is used to extract the diagnosis result corresponding to each piece of medical data in the second subset and determine whether there is adjacent medical data corresponding to the similar diagnosis result in the second subset;
  • the first obtaining module is used to obtain the time difference between the adjacent medical visit interval of the adjacent medical data and the time interval threshold if there is adjacent medical data corresponding to similar diagnosis results in the second subset The ratio of the time difference to the time interval threshold to obtain an interval anomaly factor corresponding to the adjacent medical data;
  • the fifth abnormality determination module is configured to: when the interval abnormality factor corresponding to the adjacent medical data is greater than a fifth preset threshold, the medical data meets abnormal characteristics.
  • the medical data abnormality identification device includes:
  • the fifth calculation module is used for extracting the diagnosis and treatment items corresponding to each piece of medical data in the second sub-collection, respectively comparing the diagnosis and treatment items corresponding to the adjacent treatments with the reference diagnosis and treatment item set, and obtaining the corresponding treatments for the adjacent treatments.
  • the sixth abnormality determination module is configured to: when the continuity is greater than the sixth preset threshold, the corresponding medical data meets abnormal characteristics.
  • the present application also proposes a computer-readable storage medium on which computer-readable instructions are stored.
  • the computer-readable storage medium may be a non-volatile readable storage medium.
  • the computer-readable storage medium may be the memory 201 in the medical data abnormality recognition terminal of FIG. 1, or may be a ROM (Read-Only Memory, read-only memory) / RAM (Random Access Memory (random access memory), at least one of magnetic disks and optical disks, the computer-readable storage medium includes several instructions to make a terminal device (which may be a mobile phone, computer, server, network device) with a processor Or the medical data abnormality identification terminal in the embodiments of the present application, etc.) execute the methods described in the embodiments of the present application.
  • a terminal device which may be a mobile phone, computer, server, network device

Abstract

A medical data abnormality identification method and device based on big data, a terminal, and a computer readable storage medium. The method comprises: when detecting an abnormality detection request, obtaining a target hospital corresponding to the abnormality detection request and medical data to be detected of the target hospital (S10); grouping said medical data according to a preset dimension to obtain grouped subsets (S20); analyzing each of the subsets on the basis of a preset rule corresponding to the preset dimension, and determining whether there is target medical data satisfying abnormal features in said medical data (S30); and if the target medical data satisfying the abnormality features exists in said medical data, marking the target medical data with abnormality (S40). By means of the method, disaggregated hospitalization behaviors can accurately identified, thereby effectively preventing fraudulent insurance behaviors.

Description

医疗数据异常识别方法、装置、终端及存储介质  Medical data abnormality identification method, device, terminal and storage medium The
本申请要求于2018年10月19日提交中国专利局、申请号为201811226809.0、发明名称为“医疗数据异常识别方法、装置、终端及存储介质”的中国专利申请的优先权,其全部内容通过引用结合在申请中。This application requires the priority of the Chinese patent application filed on October 19, 2018 in the Chinese Patent Office with the application number 201811226809.0 and the invention titled "Medical Data Anomaly Recognition Method, Device, Terminal and Storage Medium", the entire content of which is cited by reference Incorporated in the application.
技术领域Technical field
本申请涉及医疗数据处理技术领域,尤其涉及一种医疗数据异常识别方法、装置、终端及计算机可读存储介质。The present application relates to the technical field of medical data processing, and in particular, to a method, device, terminal, and computer-readable storage medium for identifying abnormal medical data.
背景技术Background technique
医疗保险制度是国家为预防和分担疾病所带来的医疗费用的一种社会强制性保险,费用由用人单位和个人共同缴纳,医疗保险金由医疗保险机构支付,以解决劳动者因患病或受伤害带来的医疗风险。The medical insurance system is a kind of social compulsory insurance for the state to prevent and share the medical expenses caused by diseases. The expenses are jointly paid by the employer and the individual, and the medical insurance money is paid by the medical insurance institution to solve the laborers ’illness or illness. Medical risks from injury.
医保部门会对医院进行考核,其中,单次住院天数是医院医疗效率的重要考核指标,平均单次住院天数越多,医院医疗效率越低,因此,在实际操作中,医院为提升其考核评分,将一次住院分解为多次住院,或办理虚假住院,以降低单次住院天数。这显然是违反医保规定、损害公共利益的做法。因此,需要一种识别异常医疗数据的方法。 The medical insurance department will evaluate the hospital. Among them, the number of single hospital stays is an important evaluation index of the hospital's medical efficiency. The more the average number of single hospital stays, the lower the hospital's medical efficiency. Therefore, in actual operation, the hospital will improve its evaluation score , Break down one hospitalization into multiple hospitalizations, or handle false hospitalizations to reduce the number of single hospitalizations. This is obviously a practice that violates medical insurance regulations and harms the public interest. Therefore, a method for identifying abnormal medical data is needed. The
发明内容Summary of the invention
本申请的主要目的在于提供一种医疗数据异常识别方法,旨在解决无法检测异常刷医保卡行为数据的技术问题。The main purpose of the present application is to provide a method for identifying abnormal medical data, aiming to solve the technical problem that the medical insurance card behavior data cannot be detected abnormally.
为实现上述目的,本申请提供一种医疗数据异常识别方法,其特征在于,所述医疗数据异常识别方法包括以下步骤:In order to achieve the above object, the present application provides a medical data abnormality identification method, characterized in that the medical data abnormality identification method includes the following steps:
在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;When an abnormality detection request is detected, the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained;
根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;Group the medical data to be tested according to a preset dimension to obtain a grouped subset;
基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;Analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected;
若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。If there is target medical data satisfying abnormal characteristics in the medical data to be detected, the target medical data is marked abnormally.
此外,为实现上述目的,本申请还提供一种医疗数据异常识别装置,所述医疗数据异常识别装置包括:In addition, in order to achieve the above object, the present application also provides a medical data abnormality identification device, the medical data abnormality identification device includes:
获取模块,用于在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;An obtaining module, configured to obtain the target hospital corresponding to the abnormal detection request and the medical data to be detected of the target hospital when the abnormal detection request is detected;
分组模块,用于根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;A grouping module, configured to group the medical data to be detected according to a preset dimension to obtain a grouped subset;
异常分析模块,用于基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;An anomaly analysis module, configured to analyze each of the subsets based on a preset rule corresponding to a preset dimension, and determine whether there is target medical data satisfying an abnormal feature in the medical data to be detected;
异常标记模块,用于若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。The abnormal marking module is configured to mark the target medical data abnormally if there is target medical data satisfying abnormal characteristics in the medical data to be detected.
此外,为实现上述目的,本申请还提供一种医疗数据异常识别终端,所述医疗数据异常识别终端包括处理器、存储器、以及存储在所述存储器上并可被所述处理器执行的计算机可读指令,其中所述计算机可读指令被所述处理器执行时,实现如上述的医疗数据异常识别方法的步骤。In addition, in order to achieve the above object, the present application also provides a medical data abnormality identification terminal, the medical data abnormality identification terminal includes a processor, a memory, and a computer stored on the memory and executable by the processor. Read instructions, where the computer-readable instructions are executed by the processor to implement the steps of the medical data abnormality identification method as described above.
此外,为实现上述目的,本申请还提供一种计算机可读存储介质,所述计算机可读存储介质上存储有计算机可读指令,其中所述计算机可读指令被处理器执行时,实现如上述的医疗数据异常识别方法的步骤。In addition, in order to achieve the above object, the present application also provides a computer-readable storage medium having computer-readable instructions stored on the computer-readable storage medium, wherein when the computer-readable instructions are executed by a processor, the implementation is as described above Steps of the method for identifying abnormal medical data.
附图说明BRIEF DESCRIPTION
图1是本申请实施例方案涉及的硬件运行环境的医疗数据异常识别终端结构示意图;FIG. 1 is a schematic structural diagram of a medical data abnormality recognition terminal in a hardware operating environment involved in an embodiment of the present application;
图2为本申请医疗数据异常识别方法第一实施例的流程示意图;2 is a schematic flowchart of a first embodiment of a medical data abnormality identification method of the application;
图3为本申请医疗数据异常识别方法第二实施例的流程示意图;3 is a schematic flowchart of a second embodiment of a medical data abnormality identification method of the present application;
图4为本申请医疗数据异常识别方法第五实施例的流程示意图;4 is a schematic flowchart of a fifth embodiment of a medical data abnormality identification method of the present application;
图5为本申请医疗数据异常识别装置第一实施例的功能模块示意图。FIG. 5 is a schematic diagram of functional modules of the first embodiment of the medical data abnormality recognition device of the present application.
本申请目的的实现、功能特点及优点将结合实施例,参照附图做进一步说明。The implementation, functional characteristics and advantages of the present application will be further described in conjunction with the embodiments and with reference to the drawings.
具体实施方式detailed description
应当理解,此处所描述的具体实施例仅仅用以解释本申请,并不用于限定本申请。It should be understood that the specific embodiments described herein are only used to explain the present application, and are not used to limit the present application.
请参见图1,图1为本申请所提供的医疗数据异常识别终端的硬件结构示意图。Please refer to FIG. 1, which is a schematic diagram of the hardware structure of the medical data abnormality identification terminal provided by the present application.
所述医疗数据异常识别终端可以是PC,也可以是智能手机、平板电脑、便携计算机、台式计算机等具有显示功能的设备终端,可选地,所述医疗数据异常识别终端可以是服务器设备,存在医疗数据异常识别的后端管理系统,用户通过所述后端管理系统对医疗数据异常识别终端进行管理。The medical data abnormality identification terminal may be a PC or a device terminal with a display function such as a smart phone, tablet computer, portable computer, desktop computer, etc. Optionally, the medical data abnormality identification terminal may be a server device that exists A back-end management system for medical data abnormality identification, and a user manages the medical data abnormality identification terminal through the back-end management system.
所述医疗数据异常识别终端可以包括:处理器101以及存储器201等部件。在所述医疗数据异常识别终端中,所述处理器101与所述存储器201连接,所述存储器201上存储有计算机可读指令,处理器101可以调用存储器201中存储的计算机可读指令,并实现如下述医疗数据异常识别方法各实施例的步骤。The medical data abnormality identification terminal may include components such as a processor 101 and a memory 201. In the medical data abnormality recognition terminal, the processor 101 is connected to the memory 201, and the memory 201 stores computer-readable instructions, and the processor 101 can call the computer-readable instructions stored in the memory 201, and The steps of each embodiment of the medical data abnormality recognition method described below are implemented.
所述存储器201,可用于存储软件计算机可读指令以及各种数据。存储器201可主要包括存储计算机可读指令区和存储数据区。此外,存储器201可以包括高速随机存取存储器,还可以包括非易失性存储器,例如至少一个磁盘存储器件、闪存器件、或其他易失性固态存储器件。The memory 201 can be used to store software computer readable instructions and various data. The memory 201 may mainly include an area for storing computer-readable instructions and an area for storing data. In addition, the memory 201 may include a high-speed random access memory, and may also include a non-volatile memory, such as at least one magnetic disk storage device, a flash memory device, or other volatile solid-state storage devices.
处理器101,是医疗数据异常识别终端的控制中心,利用各种接口和线路连接整个医疗数据异常识别终端的各个部分,通过运行或执行存储在存储器201内的软件计算机可读指令和/或模块,以及调用存储在存储器201内的数据,执行医疗数据异常识别终端的各种功能和处理数据,从而对医疗数据异常识别终端进行整体监控。处理器101可包括一个或多个处理单元;可选地,处理器101可集成应用处理器和调制解调处理器,其中,应用处理器主要处理操作系统、用户界面和应用计算机可读指令等,调制解调处理器主要处理无线通信。可以理解的是,上述调制解调处理器也可以不集成到处理器101中。The processor 101 is the control center of the medical data abnormality recognition terminal, and uses various interfaces and lines to connect the various parts of the entire medical data abnormality recognition terminal, by running or executing software computer readable instructions and / or modules stored in the memory 201 , And call the data stored in the memory 201 to perform various functions and process data of the medical data abnormality recognition terminal, thereby performing overall monitoring of the medical data abnormality recognition terminal. The processor 101 may include one or more processing units; optionally, the processor 101 may integrate an application processor and a modem processor, where the application processor mainly processes an operating system, a user interface, and application computer-readable instructions, etc. The modem processor mainly handles wireless communication. It can be understood that the foregoing modem processor may not be integrated into the processor 101.
本领域技术人员可以理解,图1中示出的医疗数据异常识别终端结构并不构成对医疗数据异常识别终端的限定,可以包括比图示更多或更少的部件,或者组合某些部件,或者不同的部件布置。Those skilled in the art can understand that the structure of the medical data abnormality identification terminal shown in FIG. 1 does not constitute a limitation on the medical data abnormality identification terminal, and may include more or less components than the illustration, or a combination of certain components, Or different component arrangements.
基于上述硬件结构,提出本申请方法各个实施例,在下文中的识别终端为医疗数据异常识别终端的简称。Based on the above hardware structure, various embodiments of the method of the present application are proposed, and the identification terminal in the following is an abbreviation of a medical data abnormality identification terminal.
本申请提供一种医疗数据异常识别方法。This application provides a method for identifying abnormal medical data.
参照图2,图2为本申请医疗数据异常识别方法第一实施例的流程示意图。Referring to FIG. 2, FIG. 2 is a schematic flowchart of a first embodiment of a medical data abnormality recognition method of this application.
本实施例中,所述医疗数据异常识别方法包括以下步骤:In this embodiment, the medical data abnormality identification method includes the following steps:
步骤S10,在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;Step S10, when an abnormality detection request is detected, the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained;
异常检测请求是触发本申请医疗数据异常检测方法对应计算机可读指令启动的指令,可以通过一个预设的外部事件/页面请求触发异常检测请求,如用户输入的异常检测的点击操作;也可以通过使用定时JOB(任务)的方式作为计算机可读指令的启动接口,每隔一段时间就触发进行医疗数据的异常检测,也可以在接收到待检测医疗数据后立即进行异常检测,也可以在接收的待检测医疗数据的数据量达到一定阈值后进行异常检测。可选地,本申请对医疗数据的异常检测,可以是医疗数据审核流程中的一个或多个流程节点,可由流程节点的流转自动触发医疗数据的异常检测。The anomaly detection request is an instruction that triggers the start of the computer-readable instruction corresponding to the medical data anomaly detection method of the present application. The anomaly detection request can be triggered by a preset external event / page request, such as a click operation for anomaly detection input by a user; it can also be passed Use the timed JOB (task) method as the starting interface for computer-readable instructions, which triggers anomaly detection of medical data at regular intervals. It can also perform anomaly detection immediately after receiving medical data to be detected. Anomaly detection is performed after the amount of medical data to be detected reaches a certain threshold. Optionally, the anomaly detection of medical data in this application may be one or more process nodes in the medical data review process, and the abnormality detection of medical data may be automatically triggered by the flow of the process nodes.
本实施例中,为识别以医院为违规主体主体的异常医疗数据,以待检测的目标医院的医疗数据为异常识别的基础。异常检测请求中包含有对应目标医院的标识。待检测医疗数据即异常检测请求指向的、请求检测的目标医院的特定的医疗数据,医疗数据包括但不限于:就诊类型、诊疗项目标识、就诊时间、诊断结果、用药情况、诊疗金额、用药金额等。 In this embodiment, in order to identify the abnormal medical data with the hospital as the subject of violation, the medical data of the target hospital to be detected is used as the basis for abnormal identification. The anomaly detection request contains the identification of the corresponding target hospital. The medical data to be detected is the specific medical data pointed to by the abnormal detection request and the target hospital requested for detection. The medical data includes but is not limited to: type of treatment, identification of treatment items, time of treatment, diagnosis results, medication situation, amount of treatment, amount of medication Wait. The
参保人刷医保卡后,刷卡设备会将相关医疗数据上传到医院终端,再由医院终端发送到识别终端或直接上传到识别终端,可以直接在识别终端的存储器中存储,在进行异常检测时,识别终端直接根据异常检测请求从本地存储器中获取待检测医疗数据,也可以存储在医疗数据的数据存储终端/云端,以供识别终端在进行异常医疗数据的检测时,根据异常检测请求从数据存储终端/云端获取待检测医疗数据。After the insured person swipes the medical insurance card, the card swiping device will upload the relevant medical data to the hospital terminal, and then the hospital terminal sends it to the identification terminal or directly uploads it to the identification terminal, which can be directly stored in the memory of the identification terminal, when performing abnormal detection , The identification terminal directly obtains the medical data to be detected from the local storage according to the abnormal detection request, or it can be stored in the data storage terminal / cloud of the medical data, so that the identification terminal can detect the abnormal medical data from the data according to the abnormal detection request The storage terminal / cloud obtains medical data to be tested.
步骤S20,根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;Step S20: Group the medical data to be detected according to a preset dimension to obtain a grouped subset;
预设维度包括医院维度和个人维度中的至少一个,医院维度即基于目标医院的全部医疗数据分析判断是否存在异常医疗数据,个人维度即基于各参保人的医疗数据分析判断是否存在异常医疗数据。各预设维度可以设置为可点击控件,根据用户点击操作确定用户选定的分析用预设维度,也可直接获得默认的预设维度。The preset dimension includes at least one of the hospital dimension and the personal dimension. The hospital dimension is based on the analysis of all medical data of the target hospital to determine whether there is abnormal medical data, and the personal dimension is based on the medical data analysis of each participant to determine whether there is abnormal medical data . Each preset dimension can be set as a clickable control, and the preset dimension for analysis selected by the user can be determined according to the user's click operation, or the default preset dimension can be directly obtained.
预设维度不同,对待检测医疗数据进行分组的分组方式不同。在预设维度为医院时,识别终端将待检测医疗数据按照病种进行分组,可获得各病种对应的子集合;在预设维度为个人时,识别终端将待检测医疗数据按照参保人进行分组,可获得各参保人对应的子集合。The preset dimensions are different, and the medical data to be tested are grouped in different ways. When the preset dimension is a hospital, the identification terminal groups the medical data to be tested according to the disease type, and a corresponding subset of each disease type can be obtained; when the preset dimension is an individual, the identification terminal groups the medical data to be tested according to the insured person By grouping, you can get a subset of each insured person.
可选地,识别终端可同时、分别根据医院维度和个人维度分析所述待检测医疗数据,识别出异常数据。Optionally, the identification terminal may simultaneously and separately analyze the medical data to be detected according to the hospital dimension and the individual dimension to identify abnormal data.
步骤S30,基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;Step S30: Analyze each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected;
每个预设维度都有各自对应的预设规则,各子集合为预设规则的分析对象。具体地,一实施例中,在所述预设维度为医院维度时,将所述待检测医疗数据按照病种进行分组,获得各病种对应的第一子集合,基于各病种对应的第一子集合计算各病种对应的平均单次住院天数,和/或每人平均住院次数,和/或平均单次住院金额,将各病种对应的平均单次住院天数,和/或每人平均住院次数,和/或平均单次住院金额与各病种对应的预设值进行比较,判断各病种对应的第一子集合是否满足异常特征。Each preset dimension has its own corresponding preset rule, and each subset is the analysis object of the preset rule. Specifically, in an embodiment, when the preset dimension is a hospital dimension, the medical data to be tested are grouped according to disease types to obtain a first subset corresponding to each disease type, based on the Calculate the average number of single hospitalization days corresponding to each disease type, and / or average number of hospitalizations per person, and / or average amount of single hospitalization, and calculate the average number of single hospitalization days corresponding to each disease type, and / or per person The average number of hospitalizations, and / or the average single hospitalization amount are compared with preset values corresponding to each disease type, and it is determined whether the first subset corresponding to each disease type meets the abnormal feature.
异常特征指预先设定的用于限定异常医疗数据的特征,例如,将各病种对应的平均单次住院天数与各病种对应的预设值进行比较,若任意病种对应的平均单次住院天数大于各病种对应的预设值,则该病种对应的第一子集合满足异常特征。Abnormal characteristics refer to the characteristics set in advance to limit abnormal medical data. For example, the average number of days of hospitalization corresponding to each disease type is compared with the preset value corresponding to each type of disease. The number of hospitalization days is greater than the preset value corresponding to each disease type, then the first subset corresponding to the disease type meets the abnormal characteristics.
步骤S40,若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。Step S40, if there is target medical data satisfying abnormal characteristics in the medical data to be detected, the target medical data is marked abnormally.
若待检测医疗数据存在异常的目标医疗数据,则将目标医疗数据进行异常标记,并输出异常检测结果,以提示用户进行线下核实。若待检测医疗数据不存在异常的目标医疗数据,则提示无异常。If the medical data to be detected has abnormal target medical data, the target medical data is marked abnormally, and the abnormal detection result is output to prompt the user to perform offline verification. If there is no abnormal target medical data in the medical data to be detected, it is prompted that there is no abnormality.
进一步地,为更好地进行异常标记,以便识别终端和/或用户对目标医疗数据选择对应的处理方式进行处理,获取目标医疗数据的异常类型;根据该异常类型获取对应的异常标识对待检测医疗数据进行异常标记。进一步地,在检测到用户线下核实后输入的修正指令时,将目标医疗数据的状态修改为正常。Further, in order to better mark the abnormality, so as to identify the terminal and / or the user to select the corresponding processing method for the target medical data to process, and obtain the abnormal type of the target medical data; according to the abnormal type, obtain the corresponding abnormality identifier to detect medical treatment The data is marked abnormally. Further, when the correction instruction input after the offline verification by the user is detected, the state of the target medical data is modified to be normal.
本实施例通过在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。通过以待审核/进行异常识别的目标医院为筛选条件,获得目标医院的待检测医疗数据,可有针对性地对目标医院是否违反医保规范进行分析识别;通过根据预设维度对待检测医疗数据进行分组分析,可有效检测出异常医疗数据;将待检测医疗数据中存在满足异常特征的目标医疗数据进行异常标记,可将异常医疗数据区分出来,以便后续对异常医疗数据进行针对性处理,规范医疗费用报销制度的正常运行。In this embodiment, when an abnormality detection request is detected, the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained; the medical data to be detected are grouped according to a preset dimension to obtain the grouped Sub-sets; analyze each of the sub-sets based on preset rules corresponding to preset dimensions to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be tested; For target medical data, the target medical data is abnormally marked. By taking the target hospital to be audited / abnormally identified as the screening condition, the medical data to be tested of the target hospital can be obtained, and the target hospital can be targeted to analyze and identify whether the target hospital violates the medical insurance regulations; Grouped analysis can effectively detect abnormal medical data; mark abnormal medical target data that meets abnormal characteristics in the medical data to be detected, and distinguish the abnormal medical data for subsequent targeted treatment of abnormal medical data to standardize medical treatment The normal operation of the expense reimbursement system.
进一步地,基于上述实施例,如图3,在本申请医疗数据异常识别方法第二实施例中,在所述预设维度为医院维度时,所述步骤S20包括:Further, based on the above embodiment, as shown in FIG. 3, in the second embodiment of the medical data abnormality identification method of the present application, when the preset dimension is a hospital dimension, the step S20 includes:
步骤S21,将所述待检测医疗数据按照病种进行分组,获得各病种对应的第一子集合;Step S21: Group the medical data to be tested according to the disease type, and obtain a first sub-set corresponding to each disease type;
病种,包括主诊断(如糖尿病)和副诊断/并发症(肾脏病变、眼底病变、神经病变等),在分组时,按照主诊断+副诊断,即按照细分病种对医疗数据进行分组。Disease types, including primary diagnosis (such as diabetes) and secondary diagnosis / complication (kidney disease, fundus disease, neuropathy, etc.), when grouping, according to the primary diagnosis + secondary diagnosis, that is, the medical data is grouped according to the breakdown .
所述步骤S30包括: The step S30 includes:
步骤S310,从各病种对应的第一子集合中,获取各病种的总住院次数和总住院天数,基于所述各病种的总住院次数和总住院天数计算获得各病种的平均单次住院天数;Step S310: Obtain the total number of hospitalizations and the total number of hospitalization days of each disease type from the first subset corresponding to each disease type, and calculate and obtain the average number of each disease type based on the total number of hospitalizations and the total number of hospitalization days Number of hospital stays;
各病种对应的第一子集合,包含目标医院各病种对应的所有医疗数据,不以参保人为区分标准。从各病种对应的第一子集合中,统计各病种对应总的住院次数和总的住院天数,平均单次住院天数可以通过总住院天数除以总住院次数获得。例如,糖尿病并发乳酸性酸中毒,住院总次数是20次,总住院天数140天,则该病种的平均单次住院天数为140/20=7天/次。The first sub-collection corresponding to each disease type contains all medical data corresponding to each disease type of the target hospital, and the insured person is not used as the criterion. From the first subset corresponding to each disease type, the total number of hospitalizations and the total number of hospitalization days corresponding to each disease type are counted. The average number of single hospitalization days can be obtained by dividing the total number of hospitalization days by the total number of hospitalizations. For example, if diabetes is complicated by lactic acidosis, the total number of hospitalizations is 20, and the total number of hospitalization days is 140 days, then the average number of single hospitalization days for the disease is 140/20 = 7 days / time.
各病种的平均单次住院天数指某病种的单次住院的平均天数。不同病种的平均单次住院天数不同,因此,基于各病种对应的第一子集合计算各病种对应的平均单次住院天数。The average number of hospital days per disease refers to the average number of hospital days for a disease. The average number of hospital stays for different diseases is different. Therefore, the average number of hospital stays for each disease is calculated based on the first subset corresponding to each disease.
可选地,为保证数据更为准确以及保证对偶发意外的兼容,可先将该病种对应的第一子集合中,单次住院天数高于/低于第一预设值的医疗数据标记出来,进一步核实,同时,根据剩余的医疗数据计算该病种的平均单次住院天数。如上例子中,在20次住院中,住院天数大多处于4-10天之间,但是有一次住院了2天,有一次住院了14天,则将这两个异常数据标记做进一步核实,并将这两个异常数据剔除,基于剩下的18个数据计算平均单次住院天数。Optionally, in order to ensure more accurate data and ensure compatibility with accidental accidents, the medical data of a single hospitalization day above / below the first preset value can be marked in the first subset corresponding to the disease type Come out and further verify, and at the same time, calculate the average number of days of hospitalization for the disease based on the remaining medical data. As in the above example, in the 20 hospitalizations, the number of hospitalization days is mostly between 4-10 days, but once the hospitalization was 2 days and once the hospitalization was 14 days, the two abnormal data were marked for further verification, and the These two abnormal data are eliminated, and the average number of hospital stays is calculated based on the remaining 18 data.
步骤S311,将所述各病种的平均单次住院天数与各病种对应的预设天数进行比较,获得各病种的平均单次住院天数与对应预设天数的天数差,计算各病种的所述天数差与对应预设天数的比值,得到各病种对应的天数异常因子;Step S311: Compare the average number of hospitalization days of each disease type with the preset days corresponding to each disease type, obtain the difference between the average number of hospitalization days of each disease type and the corresponding preset days, and calculate each disease type The ratio of the difference in the number of days to the corresponding preset number of days to obtain the abnormal factor for the number of days corresponding to each disease type;
预设天数根据经过审核的同级别以及同类别医疗机构中同一病种下的平均单次住院天数计算获得,同级别指“三甲医院”“二甲医院”等通用医院等级,类别指专科相同,例如同属儿童专科,同一病种包括主诊断和副诊断。预设天数可以是一个范围。The preset number of days is calculated based on the average number of hospital stays in the same class and the same type of disease in the same type of medical institutions that have been reviewed. The same level refers to the general hospital grades such as "Third Class A Hospital" and "Second Class A Hospital", and the category refers to the same specialty. For example, they belong to the specialty of children, and the same disease includes the main diagnosis and the auxiliary diagnosis. The preset number of days can be a range.
天数异常因子,指用于标识平均单次住院天数异常程度的参数。本实施例中,将各病种的平均单次住院天数与对应预设天数的天数差,与对应预设天数的比值作为各病种对应的天数异常因子。例如,若是糖尿病并发乳酸性酸中毒的预设天数为15天,而目标医院的平均单次住院天数为7天,则相差8天,则根据预设天数、平均单次住院天数、天数差计算天数异常因子,上述例子中的天数异常因子为(15-7)/15。The abnormal number of days refers to the parameter used to identify the abnormal degree of the average number of days in a single hospital stay. In this embodiment, the ratio of the difference between the average number of days of hospitalization for each disease type and the number of days corresponding to the preset number of days and the number of days corresponding to the preset number of days is used as the abnormal factor for the number of days corresponding to each disease type. For example, if the preset number of days for diabetes complicated with lactic acidosis is 15 days, and the average number of single hospital stays in the target hospital is 7 days, the difference is 8 days, then it is calculated based on the preset days, average number of single hospital stays, and the difference in days Days anomaly factor, the days anomaly factor in the above example is (15-7) / 15.
当天数异常因子=0时,即平均单次住院天数与对应预设天数的天数差为0,说明对应病种的平均单次住院天数无异常;当天数异常因子<0时,即平均单次住院天数大于对应预设天数,说明对应病种不可能存在分解住院,即平均单次住院天数无异常;当天数异常因子>0时,即平均单次住院天数小于对应预设天数,说明对应病种的平均单次住院天数有异常,数值大小标识异常程度。When the number of days abnormal factor is 0, that is, the difference between the average number of days of single hospitalization and the corresponding preset days is 0, indicating that the average number of days of corresponding single hospitalization of the corresponding disease is not abnormal; when the number of days abnormal factor <0, it is the average single The number of hospitalization days is greater than the corresponding preset number of days, indicating that there can be no decomposition hospitalization for the corresponding disease, that is, the average number of single hospitalization days is not abnormal; when the abnormality factor of the number of days> 0, the average number of single hospitalization days is less than the corresponding preset number of days, indicating that the corresponding disease The average number of hospitalization days for each species is abnormal, and the value indicates the degree of abnormality.
步骤S312,在任一病种对应的天数异常因子大于第一预设阈值时,该病种对应的第一子集合满足异常特征。Step S312, when the abnormal number of days corresponding to any disease type is greater than the first preset threshold, the first subset corresponding to the disease type satisfies the abnormal characteristics.
第一预设阈值,指由用户预设的值,可根据实际情况进行调整。The first preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
可选地,在计算得出各病种对应的天数异常因子后,可根据各病种对应的天数异常因子计算目标医院的异常评分。在对目标医院进行整体考核时,将各病种对应的天数异常因子整合起来计算目标医院的异常评分,可选地,可以将所有天数异常因子之和作为目标医院的异常评分,也可以根据各病种的不稳定程度(个体差异较大的病种)分配基准值,将各病种对应的基准值与天数异常因子的乘积之和作为目标医院的异常评分。Optionally, after calculating the abnormal number of days corresponding to each disease type, the abnormal score of the target hospital may be calculated according to the abnormal number of days corresponding to each disease type. In the overall evaluation of the target hospital, the abnormal number of days corresponding to each disease type is integrated to calculate the abnormal score of the target hospital. Optionally, the sum of all the abnormal factors of the number of days can be used as the abnormal score of the target hospital. The degree of instability of the disease (a disease with a large individual difference) is assigned a reference value, and the sum of the product of the reference value corresponding to each disease and the abnormal number of days is used as the abnormal score of the target hospital.
本实施例通过计算获得各病种的平均单次住院天数,并将目标医院的各病种的平均单次住院天数与同级别以及同类别医疗机构的同一病种的平均单次住院天数(即预设天数)进行对比,识别出目标医院的待检测医疗数据中不符合通常情况的医疗数据,并通过天数异常因子表征异常程度,在天数异常因子大于第一预设阈值,将病种对应的第一子集合判定为满足异常特征,实现对异常医疗数据的识别。In this embodiment, the average number of single hospitalization days of each disease type is obtained by calculation, and the average number of single hospitalization days of each disease type of the target hospital is compared with the average number of single hospitalization days of the same disease type and medical institution of the same class (ie Preset days) to compare, identify the medical data in the target hospital's medical data that does not meet the usual situation, and characterize the degree of abnormality by the number of days abnormal factor, when the number of days abnormal factor is greater than the first preset threshold, the corresponding disease type The first sub-set is determined to satisfy the abnormal features and realize the identification of abnormal medical data.
进一步地,基于上述实施例,在本申请医疗数据异常识别方法第三实施例中,所述步骤S30包括:Further, based on the foregoing embodiment, in the third embodiment of the medical data abnormality recognition method of the present application, the step S30 includes:
步骤S313,从各病种对应的第一子集合中,获取各病种的参保人数和总住院次数,基于各病种的参保人数和总住院次数计算获得各病种对应的每人平均住院次数;Step S313: Obtain the number of insured persons and the total number of hospitalizations of each disease type from the first subset corresponding to each disease type, and calculate the average per capita corresponding to each disease type based on the number of insured persons of each disease type and the total number of hospitalizations Number of hospitalizations;
各病种对应的第一子集合,包含目标医院各病种对应的所有医疗数据。从各病种对应的第一子集合中,统计各病种对应参保人数和总住院次数,每人平均住院次数可以通过总住院次数除以参保人数获得。例如,糖尿病并发乳酸性酸中毒,总住院次数是100次,参保人数14个,则该病种对应的每人平均住院次数为100/14。The first subset corresponding to each disease type contains all medical data corresponding to each disease type in the target hospital. From the first subset corresponding to each disease type, the number of insured persons corresponding to each disease type and the total number of hospitalizations are counted. The average number of hospitalizations per person can be obtained by dividing the total number of hospitalizations by the number of insured persons. For example, if diabetes is complicated by lactic acidosis, the total number of hospitalizations is 100, and the number of insured persons is 14, then the average number of hospitalizations per person for this disease is 100/14.
步骤S314,将各病种对应的每人平均住院次数与对应的预设次数进行比较,获得各病种的每人平均住院次数与对应预设次数的次数差,计算各病种的所述次数差与对应预设次数的比值,得到各病种对应的次数异常因子;Step S314: Compare the average number of hospitalizations per person for each disease type with the corresponding preset number of times, obtain the difference between the number of average hospitalizations per person for each disease type and the corresponding preset number of times, and calculate the number of times for each disease type The ratio of the difference to the corresponding preset number of times to obtain the abnormal factor of the number of times corresponding to each disease type;
预设次数根据经过审核的同级别以及同类别医疗机构中同一病种下同一诊断(主诊断/副诊断)的平均住院次数计算获得,预设次数可等于所有同级别以及同类别医疗机构中同一病种同一诊断(主诊断/副诊断)的平均住院次数。The preset number of times is calculated based on the average number of hospitalizations of the same diagnosis (primary diagnosis / subdiagnosis) of the same disease in the same level and the same category of medical institutions under review. The average number of hospitalizations for the same diagnosis (primary diagnosis / subdiagnosis) of the same type of disease.
次数异常因子,指用于标识每人平均住院次数异常程度的参数。本实施例中,将各病种的每人平均住院次数与对应预设次数的次数差,与对应预设次数的比值作为各病种对应的次数异常因子。例如,若是糖尿病并发乳酸性酸中毒的每人平均住院次数为10次,而目标医院的每人平均住院次数为17次,相差7次,则根据预设次数、每人平均住院次数、次数差计算次数异常因子,上述例子中的次数异常因子为(17-10)/10。The number of abnormal factors refers to the parameter used to identify the abnormal degree of the average number of hospitalizations per person. In this embodiment, the ratio between the average number of hospitalizations per person of each disease type and the number of times corresponding to the preset number of times, and the ratio of the number of times corresponding to the preset number of times as the abnormality factor of the number of times corresponding to each disease type. For example, if the average number of hospitalizations per person for diabetes complicated with lactic acidosis is 10, and the average number of hospitalizations per person for the target hospital is 17, a difference of 7 times, according to the preset number of times, the average number of hospitalizations per person, the number of differences Calculate the frequency anomaly factor. The frequency anomaly factor in the above example is (17-10) / 10.
当次数异常因子=0时,即每人平均住院次数与对应预设次数的次数差为0,说明对应病种的每人平均住院次数无异常;当次数异常因子<0时,即每人平均住院次数小于对应预设次数,说明对应病种不可能存在分解住院,即每人平均住院次数无异常;当次数异常因子>0时,即每人平均住院次数大于对应预设次数,说明对应病种的每人平均住院次数有异常,数值大小标识异常程度,数值越大,异常程度越大。When the number of abnormal factors is 0, that is, the difference between the average number of hospitalizations per person and the corresponding preset number of times is 0, indicating that the average number of hospitalizations per person for the corresponding disease type is not abnormal; when the number of abnormal factors <0, the average The number of hospitalizations is less than the corresponding preset number, indicating that there can be no decomposition hospitalization for the corresponding disease, that is, the average number of hospitalizations per person is not abnormal; when the number of abnormal factors is> 0, the average number of hospitalizations per person is greater than the corresponding preset number, indicating the corresponding disease The average number of hospitalizations per person for each species is abnormal, and the value indicates the degree of abnormality. The larger the value, the greater the degree of abnormality.
步骤S315,在任一病种对应的次数异常因子大于第二预设阈值时,该病种对应的第一子集合满足异常特征。Step S315, when the abnormality factor of the number of times corresponding to any disease type is greater than the second preset threshold, the first subset corresponding to the disease type satisfies the abnormal characteristics.
第二预设阈值,指由用户预设的值,可根据实际情况进行调整。The second preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
可选地,在计算得出各病种对应的次数异常因子后,可根据各病种对应的次数异常因子计算目标医院的异常评分。在对目标医院进行整体考核时,将各病种对应的次数异常因子整合起来计算目标医院的异常评分,可选地,可以将所有次数异常因子之和作为目标医院的异常评分;也可以根据各病种的不稳定程度(个体差异较大的病种)分配基准值,将各病种对应的基准值与次数异常因子的乘积之和作为目标医院的异常评分;还可以将各病种对应的天数异常因子和次数异常因子整合起来计算目标医院的整体异常评分,参与维度更多,异常评分更为准确。Optionally, after calculating the abnormal factor of the number of times corresponding to each disease type, the abnormal score of the target hospital may be calculated according to the abnormal factor of the number of times corresponding to each disease type. In the overall evaluation of the target hospital, the abnormal factors of the number of times corresponding to each disease are integrated to calculate the abnormal score of the target hospital. Optionally, the sum of all the abnormal factors of the number of times can be used as the abnormal score of the target hospital; The degree of instability of the disease type (the disease type with large individual difference) is assigned a reference value, and the sum of the product of the reference value corresponding to each disease type and the number of abnormal factors is used as the abnormal score of the target hospital; The abnormal number of days and the abnormal number of times are combined to calculate the overall abnormal score of the target hospital, with more participation dimensions and more accurate abnormal scores.
本实施例通过计算获得各病种的每人平均住院次数,并将目标医院的各病种的每人平均住院次数与同级别以及同类别医疗机构的同一病种的每人平均住院次数(即预设次数)进行对比,识别出目标医院的待检测医疗数据中不符合通常情况的医疗数据,并通过次数异常因子表征异常程度,在次数异常因子大于第二预设阈值,将病种对应的第一子集合判定为满足异常特征,实现对异常医疗数据的识别。In this embodiment, the average number of hospitalizations per person of each disease type is obtained by calculation, and the average number of hospitalizations per person of each disease type in the target hospital is compared with the average number of hospitalizations per person of the same disease type and medical institution of the same class (ie Preset times) to compare, identify the medical data in the target hospital's medical data that does not meet the usual situation, and characterize the degree of abnormality by the number of times abnormal factor, when the number of times abnormal factor is greater than the second preset threshold, the corresponding disease type The first sub-set is determined to satisfy the abnormal features and realize the identification of abnormal medical data.
进一步地,基于上述实施例,在本申请医疗数据异常识别方法第四实施例中,所述步骤S30包括:Further, based on the foregoing embodiment, in the fourth embodiment of the medical data abnormality recognition method of the present application, the step S30 includes:
步骤S316,从各病种对应的第一子集合中,获取各病种的总住院次数和总住院金额,基于所述各病种的总住院次数和总住院金额计算获得各病种的平均单次住院金额;Step S316: Obtain the total number of hospitalizations and total hospitalization amount of each disease type from the first subset corresponding to each disease type, and calculate and obtain the average bill of each disease type based on the total number of hospitalizations and total hospitalization amount of each disease type Amount of second hospitalization;
从各病种对应的第一子集合中,统计各病种对应总的住院次数和总的住院金额,平均单次住院金额可以通过总住院金额除以总住院次数获得。例如,糖尿病并发乳酸性酸中毒,住院总金额是10万,总住院次数20次,则该病种的平均单次住院金额为100000/20=5000元/次。From the first subset corresponding to each disease type, the total number of hospitalizations and total hospitalization amount corresponding to each disease type are counted. The average single hospitalization amount can be obtained by dividing the total hospitalization amount by the total number of hospitalizations. For example, if diabetes is complicated by lactic acidosis, the total amount of hospitalization is 100,000, and the total number of hospitalizations is 20, then the average single hospitalization for the disease is 100,000 / 20 = 5,000 yuan / time.
各病种的平均单次住院金额指某病种的单次住院的平均金额。不同病种的平均单次住院金额不同,因此,基于各病种对应的第一子集合计算各病种对应的平均单次住院金额。The average amount of single hospitalization for each disease refers to the average amount of single hospitalization for a certain disease. The average single hospitalization amount for different diseases is different. Therefore, the average single hospitalization amount for each disease type is calculated based on the first subset corresponding to each disease type.
可选地,为保证数据更为准确以及保证对偶发意外的兼容,可先将该病种对应的第一子集合中,单次住院金额高于/低于第一预设值的医疗数据标记出来,进一步核实,同时,根据剩余的医疗数据计算该病种的平均单次住院金额。Optionally, in order to ensure more accurate data and compatibility with accidental accidents, the medical data of a single hospitalization amount higher / lower than the first preset value may be marked in the first subset corresponding to the disease type Come out and further verify, at the same time, calculate the average single hospitalization amount of the disease based on the remaining medical data.
步骤S317,将所述各病种的平均单次住院金额与对应的预设金额进行比较,获得各病种的平均单次住院金额与对应预设金额的金额差,计算各病种的所述金额差与对应预设金额的比值,得到各病种对应的金额异常因子;Step S317, compare the average single hospitalization amount of each disease type with the corresponding preset amount, obtain the difference between the average single hospitalization amount of each disease type and the corresponding preset amount, and calculate the The ratio of the amount difference to the corresponding preset amount to obtain the amount abnormality factor corresponding to each disease type;
预设金额根据经过审核的同级别以及同类别医疗机构中同一病种下的平均单次住院金额计算获得,同级别指“三甲医院”“二甲医院”等通用医院等级,类别指专科相同,例如同属儿童专科,同一病种包括主诊断和副诊断。预设金额可以是一个数值范围。The preset amount is calculated based on the average single hospitalization amount of the same class and the same disease in the medical institutions of the same class that have been reviewed. For example, they belong to the specialty of children, and the same disease includes the main diagnosis and the auxiliary diagnosis. The preset amount can be a range of values.
金额异常因子,指用于标识平均单次住院金额异常程度的参数。本实施例中,将各病种的平均单次住院金额与对应预设金额的金额差,与对应对应预设金额的比值作为各病种对应的金额异常因子。例如,若是糖尿病并发乳酸性酸中毒的预设金额为10000元/次,而目标医院的平均单次住院金额为5000元/次,则相差5000元/次,则根据预设金额、平均单次住院金额、金额差计算金额异常因子,上述例子中的金额异常因子为(10000-5000)/10000。若是平均单次住院金额比较少,则说明可能被分担到另外一次住院上,即存在分解住院的可能。The amount abnormality factor refers to the parameter used to identify the abnormal degree of the average single hospitalization amount. In this embodiment, the ratio of the difference between the average single hospitalization amount of each disease type and the corresponding preset amount and the corresponding preset amount is used as the amount abnormality factor corresponding to each disease type. For example, if the preset amount of diabetes complicated with lactic acidosis is 10,000 yuan / time, and the average single hospitalization amount of the target hospital is 5,000 yuan / time, the difference is 5000 yuan / time, according to the preset amount, the average single The hospitalization amount and the amount difference are calculated as the amount abnormality factor. The amount abnormality factor in the above example is (10000-5000) / 10000. If the average amount of a single hospitalization is relatively small, it may be shared with another hospitalization, that is, there may be decomposition of hospitalization.
当金额异常因子<0或=1时,说明对应病种的平均单次住院金额无异常,当金额异常因子<1时,说明有异常,数值越小,异常程度越大。When the amount abnormality factor <0 or = 1, it means that the average single hospitalization amount of the corresponding disease type is not abnormal. When the amount abnormality factor <1, it means there is an abnormality. The smaller the value, the greater the degree of abnormality.
步骤S318,在任一病种对应的金额异常因子大于第三预设阈值时,该病种对应的第一子集合满足异常特征。Step S318, when the amount abnormality factor corresponding to any disease type is greater than the third preset threshold, the first subset corresponding to the disease type meets the abnormal characteristics.
第三预设阈值,指由用户预设的值,可根据实际情况进行调整。The third preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
可选地,在计算得出各病种对应的金额异常因子后,可根据各病种对应的金额异常因子计算目标医院的异常评分。在对目标医院进行整体考核时,将各病种对应的金额异常因子整合起来计算目标医院的异常评分,可选地,可以将所有金额异常因子之和作为目标医院的异常评分;也可以根据各病种的不稳定程度(个体差异较大的病种)分配基准值,将各病种对应的基准值与金额异常因子的乘积之和作为目标医院的异常评分;也可基于金额异常因子、天数异常因子和次数异常因子计算目标医院的异常评分。Optionally, after calculating the amount abnormality factor corresponding to each disease type, the abnormal score of the target hospital may be calculated according to the amount abnormality factor corresponding to each disease type. In the overall assessment of the target hospital, the abnormal amount of money corresponding to each disease type is integrated to calculate the abnormal score of the target hospital. Optionally, the sum of all abnormal amounts of money can be used as the abnormal score of the target hospital; The degree of instability of the disease type (the disease with large individual difference) is assigned a reference value, and the sum of the product of the reference value corresponding to each disease type and the amount abnormality factor is used as the abnormal score of the target hospital; it can also be based on the amount abnormality factor and the number of days The abnormal factor and the frequency abnormal factor calculate the abnormal score of the target hospital.
本实施例通过计算获得各病种的平均单次住院金额,并将目标医院的各病种的平均单次住院金额与同级别以及同类别医疗机构的同一病种的平均单次住院金额(即预设金额)进行对比,识别出目标医院的待检测医疗数据中不符合通常情况的医疗数据,并通过金额异常因子表征异常程度,在金额异常因子大于第三预设阈值,将病种对应的第一子集合判定为满足异常特征,实现对异常医疗数据的识别。In this embodiment, the average single hospitalization amount of each disease type is obtained by calculation, and the average single hospitalization amount of each disease type of the target hospital is compared with the average single hospitalization amount of the same type and type of medical institution (ie. Preset amount) to compare, identify the medical data in the target hospital's medical data that does not meet the usual situation, and characterize the degree of abnormality by the amount abnormality factor, when the amount abnormality factor is greater than the third preset threshold, the corresponding disease type The first sub-set is determined to satisfy the abnormal features and realize the identification of abnormal medical data.
进一步地,基于上述实施例,如图4,在本申请医疗数据异常识别方法第五实施例中,在所述预设维度为个人维度时,所述步骤S20包括:Further, based on the above embodiment, as shown in FIG. 4, in the fifth embodiment of the medical data abnormality recognition method of the present application, when the preset dimension is a personal dimension, the step S20 includes:
步骤S22,根据参保人将所述待检测医疗数据进行分组,获得各参保人对应的第二子集合;Step S22: Group the medical data to be tested according to the insured persons to obtain a second subset corresponding to each insured person;
以参保人为单位,获得待检测医疗数据中各参保人对应的待检测医疗数据,包括参保人每次刷卡就诊的就诊类型、诊疗项目标识、就诊时间、诊断结果、用药情况、诊疗金额、用药金额等。各参保人对应的待检测医疗数据集合为第二子集合。Take the insured as the unit to obtain the medical data to be tested corresponding to each insured in the medical data to be tested, including the type of treatment, identification of the treatment item, time of diagnosis, diagnosis result, medication situation, and amount of treatment , Amount of medication, etc. The medical data set to be tested corresponding to each insured person is the second subset.
所述步骤S30包括:The step S30 includes:
步骤S320,提取所述第二子集合中每条医疗数据对应的就诊时间,计算获得所述第二子集合中相邻医疗数据的相邻就诊间隔;Step S320, extracting the consultation time corresponding to each piece of medical data in the second sub-collection, and calculating the interval between adjacent consultations to obtain the adjacent medical data in the second sub-collection;
识别终端可从医疗数据中获取每次就诊的就诊时间,其中,每次就诊都产生一条对应医疗数据,按照就诊时间先后顺序进行排列,再计算排列相邻医疗数据的相邻就诊间隔。The identification terminal can obtain the visit time of each visit from the medical data, wherein each visit generates a corresponding piece of medical data, which is arranged in order of the visit time, and then calculates the adjacent visit interval for arranging the adjacent medical data.
一实施例中,识别终端获取第二子集合中所有相邻医疗数据的相邻就诊间隔;另一实施例中,将第二子集合按照病种进行再次分组,获得第三子集合,将第三子集合中的各条医疗数据按照就诊时间先后顺序进行排列,计算相同病种的相邻住院就诊的相邻就诊间隔。In one embodiment, the identification terminal obtains the adjacent visit intervals of all adjacent medical data in the second subset; in another embodiment, the second subset is regrouped according to the disease type to obtain the third subset, and the third Each piece of medical data in the three sub-collections is arranged according to the order of visit time, and the adjacent visit interval of the adjacent hospital visits of the same disease type is calculated.
步骤S321,获取预设的时间间隔阈值,计算所述相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述第二子集合中每条医疗数据对应的间隔异常因子;Step S321: Obtain a preset time interval threshold, calculate a time difference between the adjacent consultation interval and the time interval threshold, calculate a ratio of the time difference to the time interval threshold, and obtain each item in the second subset The interval anomaly factor corresponding to medical data;
获取预设的时间间隔阈值,判断各条医疗数据对应的相邻就诊间隔是否小于时间间隔阈值,若小于,则说明该条医疗数据可能存在可疑的分解住院行为。在一个实施例中,识别终端可计算相邻就诊间隔与时间间隔阈值的差值,根据该差值确定每条医疗数据对应的间隔异常因子,当相邻就诊间隔小于时间间隔阈值时,二者的差值越大,间隔异常因子越大,当相邻就诊间隔大于或等于时间间隔阈值时,二者的差值越大,间隔异常因子越小。Obtain a preset time interval threshold and determine whether the adjacent medical visit interval corresponding to each piece of medical data is less than the time interval threshold. If it is less, it indicates that there may be suspicious decomposition of hospitalization in this piece of medical data. In one embodiment, the recognition terminal may calculate the difference between the adjacent visit interval and the time interval threshold, and determine the interval anomaly factor corresponding to each piece of medical data according to the difference. When the adjacent visit interval is less than the time interval threshold, the two The greater the difference is, the greater the interval anomaly factor. When the adjacent visit interval is greater than or equal to the time interval threshold, the greater the difference between the two, the smaller the interval anomaly factor.
因为相邻就诊间隔至少涉及到两条医疗数据,本实施例中,每条医疗数据对应至少一个间隔异常因子,例如,[1,2],[2,3]等,其中,数字指单个参保人的住院次数的序号,按照时间顺序排列,则对于第2次住院对应的医疗数据,至少对应两个间隔异常因子,分别为第2次住院与第1次住院的间隔异常因子和第2次住院与第3次住院的间隔异常因子。Because the adjacent visit interval involves at least two pieces of medical data, in this embodiment, each piece of medical data corresponds to at least one interval anomaly factor, for example, [1, 2], [2, 3], etc., where the number refers to a single parameter The serial number of the insured ’s hospitalization times is arranged in chronological order. For the medical data corresponding to the second hospitalization, there are at least two interval anomaly factors, which are the interval anomaly factor and the second hospitalization for the second hospitalization and the first hospitalization, respectively. Abnormal interval factor between the second hospitalization and the third hospitalization.
步骤S322,在所述第二子集合中的医疗数据对应的间隔异常因子大于第四预设阈值时,该医疗数据满足异常特征。Step S322, when the interval abnormality factor corresponding to the medical data in the second subset is greater than the fourth preset threshold, the medical data meets the abnormality feature.
第四预设阈值,指由用户预设的值,可根据实际情况进行调整。The fourth preset threshold refers to a value preset by the user and can be adjusted according to actual conditions.
本实施例通过提取所述第二子集合中每条医疗数据对应的就诊时间,计算获得所述第二子集合中相邻医疗数据的相邻就诊间隔;获取预设的时间间隔阈值,计算所述相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述第二子集合中每条医疗数据对应的间隔异常因子;在所述第二子集合中的医疗数据对应的间隔异常因子大于第四预设阈值时,该医疗数据满足异常特征,因为对于同一个参保人,若是相邻住院的间隔时长过短,则很可能存在分解住院的嫌疑,通过计算相邻医疗数据的相邻就诊间隔,并基于每条医疗数据对应的间隔异常因子筛选出可疑程度大的医疗数据,可准确判断医疗数据中是否包含可疑的分解住院行为,有效防止出现骗保行为,减少公众利益损失。In this embodiment, by extracting the visit time corresponding to each piece of medical data in the second subset, the neighboring visit interval of the neighboring medical data in the second subset is calculated; the preset time interval threshold is obtained, and the The time difference between the adjacent visit interval and the time interval threshold, calculating the ratio of the time difference to the time interval threshold to obtain the interval anomaly factor corresponding to each piece of medical data in the second subset; in the second When the interval anomaly factor corresponding to the medical data in the subset is greater than the fourth preset threshold, the medical data meets the anomaly characteristics, because for the same insured person, if the interval between adjacent hospitalizations is too short, there may be decomposition hospitalization Suspected, by calculating the adjacent medical interval of adjacent medical data, and screening out the medical data with a large degree of suspiciousness based on the interval abnormality factor corresponding to each medical data, it can accurately determine whether the medical data contains suspicious decomposition of hospitalization behavior, effective Prevent fraudulent behavior and reduce loss of public interest.
进一步地,所述步骤S321的步骤之后包括:Further, the step after the step S321 includes:
步骤S323,提取所述第二子集合中每条医疗数据对应的诊断结果,判断所述第二子集合中是否存在对应相似诊断结果的相邻医疗数据;Step S323: Extract the diagnosis result corresponding to each piece of medical data in the second subset, and determine whether there is adjacent medical data corresponding to a similar diagnosis result in the second subset;
诊断结果指医生对于参保人病由的判断,例如,诊断为糖尿病并发乳酸性酸中毒,诊断结果包括主诊断和副诊断。The diagnosis result refers to the doctor's judgment on the cause of the insured person's illness. For example, the diagnosis is diabetic complicated with lactic acidosis. The diagnosis result includes the main diagnosis and the auxiliary diagnosis.
本实施例中的相似诊断结果包括相同诊断结果和相似诊断结果,可预先建立诊断结果库,将名称不同的相同诊断结果以及相似的诊断结果存入诊断结果库,在判断相邻医疗数据的诊断结果是否为相似诊断结果时,通过查询诊断结果库判断。The similar diagnosis results in this embodiment include the same diagnosis results and similar diagnosis results. A diagnosis result database can be established in advance, and the same diagnosis results and similar diagnosis results with different names can be stored in the diagnosis result database to determine the diagnosis of adjacent medical data. When the result is similar to the diagnosis result, it can be judged by querying the diagnosis result database.
步骤S323,若所述第二子集合中存在对应相似诊断结果的相邻医疗数据,则获取所述相邻医疗数据的相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述相邻医疗数据对应的间隔异常因子;Step S323, if there is adjacent medical data corresponding to a similar diagnosis result in the second subset, the time difference between the adjacent visit interval of the adjacent medical data and the time interval threshold is obtained, and the time difference and The ratio of the time interval threshold to obtain the interval anomaly factor corresponding to the adjacent medical data;
若某两条或多条相邻医疗数据对应相似诊断结果,则该两条或多条相邻医疗数据有很大的分解住院可能,则进一步获取该两条或多条相邻医疗数据共同对应的间隔异常因子,判断该两条或多条相邻医疗数据的就诊时间是否存在异常(若存在异常,则异常程度的大小是多少)。If two or more adjacent medical data correspond to similar diagnosis results, the two or more adjacent medical data have a great possibility of decomposition and hospitalization, and then further obtain the two or more adjacent medical data to correspond together The interval anomaly factor determines whether the two or more adjacent medical data have an abnormal time (if there is an abnormality, the size of the abnormality).
步骤S324,在所述相邻医疗数据对应的间隔异常因子大于第五预设阈值时,该医疗数据满足异常特征。Step S324, when the interval anomaly factor corresponding to the adjacent medical data is greater than the fifth preset threshold, the medical data meets the anomaly characteristics.
在相邻医疗数据对应的间隔异常因子大于第五预设阈值时,进一步加大了相邻医疗数据为分解住院医疗数据的可能。因为若是相邻医疗数据对应的就诊时间间隔很小,同时诊断结果相同或相似,则该相邻医疗数据很可能为分解住院的数据。When the interval anomaly factor corresponding to the adjacent medical data is greater than the fifth preset threshold, the possibility that the adjacent medical data is decomposed into inpatient medical data is further increased. Because if the medical treatment interval corresponding to the adjacent medical data is small and the diagnosis results are the same or similar, the adjacent medical data is likely to be the data for decomposing hospitalization.
本实施例通过提取所述第二子集合中每条医疗数据对应的诊断结果,判断所述第二子集合中是否存在对应相似诊断结果的相邻医疗数据;若所述第二子集合中存在对应相似诊断结果的相邻医疗数据,则获取所述相邻医疗数据的相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述相邻医疗数据对应的间隔异常因子;在所述相邻医疗数据对应的间隔异常因子大于第五预设阈值时,该医疗数据满足异常特征,即:将相邻医疗数据的诊断结果和相邻就诊间隔作为判断相邻医疗数据是否满足异常特征的基准参数,可更为准确地识别出分解住院行为,有效防止出现骗保行为,减少公众利益损失。In this embodiment, by extracting the diagnosis result corresponding to each piece of medical data in the second subset, it is determined whether there is adjacent medical data corresponding to a similar diagnosis result in the second subset; if there is in the second subset Adjacent medical data corresponding to similar diagnosis results, the time difference between the adjacent medical interval of the adjacent medical data and the time interval threshold is obtained, and the ratio of the time difference to the time interval threshold is calculated to obtain the adjacent The interval anomaly factor corresponding to the medical data; when the interval anomaly factor corresponding to the adjacent medical data is greater than the fifth preset threshold, the medical data satisfies the abnormal feature, that is, the diagnosis result of the adjacent medical data and the interval between adjacent visits As a reference parameter for judging whether the adjacent medical data meets the abnormal characteristics, it can more accurately identify the decomposition of hospitalization behavior, effectively prevent fraudulent insurance behavior, and reduce the loss of public interest.
进一步地,基于上述实施例,在本申请医疗数据异常识别方法第六实施例中,所述步骤S30包括:Further, based on the foregoing embodiment, in the sixth embodiment of the medical data abnormality recognition method of the present application, the step S30 includes:
步骤S325,提取所述第二子集合中每条医疗数据对应的诊疗项目,将相邻就诊各自对应的诊疗项目与参考诊疗项目集合分别进行对比,获得相邻就诊各自对应的诊疗项目与参考诊疗项目集合的重合比例,并计算所有相邻就诊的平均重合比例,得到相邻就诊的诊疗项目的连续度;Step S325: Extract the diagnosis and treatment items corresponding to each piece of medical data in the second sub-collection, and compare the diagnosis and treatment items corresponding to each adjacent consultation with the reference diagnosis and treatment item set respectively to obtain the corresponding diagnosis and treatment items and reference diagnosis and treatment for each adjacent treatment The coincidence ratio of the item set, and calculate the average coincidence ratio of all adjacent visits to obtain the continuity of the adjacent treatment items;
识别终端根据就诊时间先后顺序对每次的住院就诊进行排列后,可获取相邻的住院就诊中包含的诊疗项目标识,并将相邻就诊各自对应的诊疗项目与参考诊疗项目集合分别进行对比,获得相邻就诊各自对应的诊疗项目与参考诊疗项目集合的重合比例,并计算所有相邻就诊的平均重合比例,得到相邻就诊的诊疗项目的连续度。可预先建立与各种诊断结果对应的诊疗规范数据库,包含各诊断结果对应的诊疗项目(标识),因为对一个病的治疗,往往遵循一定的临床/治疗路径,因此,将各诊断结果对应的诊疗项目基于一定的临床/治疗路径进行先后顺序排列。After the identification terminal arranges each inpatient consultation according to the time sequence of the consultation, it can obtain the identification of the treatment items included in the adjacent inpatient consultations, and compare the corresponding treatment items of the adjacent consultations with the reference set of treatment items, Obtain the coincidence ratio of the corresponding treatment items of the adjacent consultations and the set of reference treatment items, and calculate the average coincidence ratio of all the adjacent consultations to obtain the continuity of the treatment items of the adjacent consultations. A database of diagnosis and treatment specifications corresponding to various diagnosis results can be established in advance, including the diagnosis and treatment items (identification) corresponding to each diagnosis result. Because the treatment of a disease often follows a certain clinical / treatment path, therefore, the corresponding diagnosis results The diagnosis and treatment items are arranged in sequence based on a certain clinical / treatment path.
在将相邻就诊各自对应的诊疗项目与参考诊疗项目集合分别进行对比,获得相邻就诊各自对应的诊疗项目与参考诊疗项目集合的重合比例,并计算所有相邻就诊的平均重合比例,得到相邻就诊的诊疗项目的连续度时,获取相邻就诊对应的目标诊断结果,查询诊疗规范数据库,从规范数据库中获得目标诊断结果对应的具有的参考诊疗项目集合。将相邻就诊各自对应的诊疗项目与参考诊疗项目集合分别进行对比,获得相邻就诊各自对应的诊疗项目与参考诊疗项目集合的重合比例,即相邻就诊各自对应的诊疗项目中有多大比例的诊疗项目在参考诊疗项目集合中,具体为:属于参考诊疗项目集合中的诊疗项目占相邻就诊诊疗项目的比例,并计算所有相邻就诊的平均重合比例,该平均重合比例为相邻就诊的诊疗项目的连续度。例如,第n次就诊于第n+1次就诊为相邻就诊,第n次的诊疗项目为A、B、C,第n+1次就诊的诊疗项目为D、E、F、G、H,参考诊疗项目集合为[A、B、C、D、E、F、G],则第n次就诊对应的诊疗项目与参考诊疗项目集合的重合比例为100%,第n+1次就诊对应的诊疗项目与参考诊疗项目集合的重合比例为80%,则所有相邻就诊的平均重合比例为(100%+80%)/2=90%。Comparing the corresponding diagnosis and treatment items of the adjacent consultations with the reference diagnosis and treatment item sets respectively to obtain the coincidence ratio of the corresponding diagnosis and treatment items of the adjacent consultations and the reference diagnosis and treatment item set, and calculating the average coincidence ratio of all adjacent visits to obtain the corresponding When the continuity of the diagnosis and treatment items of the neighboring visits is obtained, the target diagnosis result corresponding to the neighboring visits is obtained, the diagnosis specification database is queried, and the reference diagnosis item set corresponding to the target diagnosis result is obtained from the specification database. Compare the corresponding diagnosis and treatment items of the adjacent consultations with the reference diagnosis and treatment item sets respectively to obtain the coincidence ratio of the corresponding diagnosis and treatment items of the adjacent consultations and the reference diagnosis and treatment item set, that is, what proportion of the corresponding diagnosis and treatment items of the adjacent treatments The diagnosis and treatment items are in the reference diagnosis and treatment item set, specifically: the diagnosis and treatment items in the reference diagnosis and treatment item set account for the proportion of the adjacent diagnosis and treatment items, and the average coincidence ratio of all adjacent visits is calculated, and the average coincidence ratio is that of the adjacent consultations Continuity of diagnosis and treatment items. For example, the nth visit is the n + 1 visit as a neighboring visit, the nth visit is A, B, C, and the n + 1 visit is D, E, F, G, H , The reference diagnosis and treatment item set is [A, B, C, D, E, F, G], then the coincidence ratio of the diagnosis and treatment items corresponding to the nth visit and the reference diagnosis and treatment item set is 100%, corresponding to the n + 1th visit The coincidence ratio of the diagnosis and treatment items and the reference diagnosis and treatment item set is 80%, then the average coincidence ratio of all adjacent visits is (100% + 80%) / 2 = 90%.
步骤S326,在所述连续度大于第六预设阈值时,对应的医疗数据满足异常特征。Step S326, when the continuity is greater than the sixth preset threshold, the corresponding medical data meets abnormal characteristics.
第六预设阈值,指由用户预设的值,可根据实际情况进行调整,在上述实例中,第六预设阈值可以为45%。The sixth preset threshold refers to a value preset by the user and can be adjusted according to actual conditions. In the above example, the sixth preset threshold may be 45%.
可选地,本实施例中步骤S325之前还可包括基于相邻医疗数据的相邻就诊间隔和诊断结果的相似性的判断,具体包括:Optionally, before step S325 in this embodiment, it may further include a judgment based on the similarity between the adjacent medical intervals of the adjacent medical data and the diagnosis results, specifically including:
提取所述第二子集合中每条医疗数据对应的诊断结果,判断所述第二子集合中是否存在对应相似诊断结果的相邻医疗数据;若所述第二子集合中存在对应相似诊断结果的相邻医疗数据,则获取所述相邻医疗数据的相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述相邻医疗数据对应的间隔异常因子;若所述相邻医疗数据对应的间隔异常因子大于第五预设阈值,则提取所述第二子集合中每条医疗数据对应的诊疗项目,将相邻就诊各自对应的诊疗项目与参考诊疗项目集合分别进行对比,获得相邻就诊各自对应的诊疗项目与参考诊疗项目集合的重合比例,并计算所有相邻就诊的平均重合比例,得到相邻就诊的诊疗项目的连续度;在所述连续度大于第六预设阈值时,对应的医疗数据满足异常特征。其中,相邻医疗数据的相邻就诊间隔和诊断结果的相似性的相关描述已在第五实施例中描述,此处不赘述。基于相邻医疗数据的相邻就诊间隔、诊断结果的相似性和相邻就诊的诊疗项目的连续度,可提升异常医疗数据识别的精确性,减少误报,提升异常检测的灵活性。Extracting the diagnosis result corresponding to each piece of medical data in the second sub-set to determine whether there is adjacent medical data corresponding to a similar diagnosis in the second sub-set; if there is a corresponding similar diagnosis in the second sub-set Adjacent medical data, the time difference between the adjacent medical interval of the adjacent medical data and the time interval threshold is obtained, and the ratio of the time difference to the time interval threshold is calculated to obtain the corresponding Interval anomaly factor; if the interval anomaly factor corresponding to the adjacent medical data is greater than the fifth preset threshold, extract the diagnosis and treatment items corresponding to each piece of medical data in the second subset, and separate the corresponding diagnosis and treatment items of the adjacent treatments Compare with the reference diagnosis and treatment item set respectively to obtain the coincidence ratio of the corresponding diagnosis and treatment items of the adjacent consultation and the reference diagnosis and treatment item set, and calculate the average coincidence ratio of all adjacent consultations to obtain the continuity of the adjacent treatment items; When the continuity is greater than the sixth preset threshold, the corresponding medical data meets abnormal characteristics. Among them, the related description of the similarity between the adjacent medical visits of the adjacent medical data and the similarity of the diagnosis results has been described in the fifth embodiment, and will not be repeated here. The interval between adjacent visits based on adjacent medical data, the similarity of diagnosis results, and the continuity of the diagnosis and treatment items of adjacent visits can improve the accuracy of identifying abnormal medical data, reduce false positives, and increase the flexibility of abnormal detection.
本实施例通过分析相邻就诊的诊疗项目的连续度,在所述连续度大于第六预设阈值时,对应的医疗数据满足异常特征,可基于临床治疗路径实现对分解住院行为的判断,有效防止出现骗保行为,减少公众利益损失。In this embodiment, by analyzing the continuity of the diagnosis and treatment items of adjacent visits, when the continuity is greater than the sixth preset threshold, the corresponding medical data satisfies the abnormal characteristics, and the judgment on the decomposition of the hospitalization behavior can be realized based on the clinical treatment path, which is effective Prevent fraudulent behavior and reduce loss of public interest.
此外,本申请还提供一种与上述医疗数据异常识别方法各步骤对应的医疗数据异常识别装置。In addition, the present application also provides a medical data abnormality recognition device corresponding to each step of the foregoing medical data abnormality recognition method.
参照图5,图5为本申请医疗数据异常识别装置第一实施例的功能模块示意图。Referring to FIG. 5, FIG. 5 is a schematic diagram of functional modules of the first embodiment of the medical data abnormality recognition device of the present application.
在本实施例中,本申请医疗数据异常识别装置包括:In this embodiment, the medical data abnormality identification device of the present application includes:
获取模块10,用于在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;The obtaining module 10 is configured to obtain the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital when the abnormality detection request is detected;
分组模块20,用于根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;A grouping module 20, configured to group the medical data to be detected according to a preset dimension to obtain a grouped subset;
异常分析模块30,用于基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;An anomaly analysis module 30, configured to analyze each of the subsets based on a preset rule corresponding to a preset dimension, and determine whether there is target medical data satisfying anomalous characteristics in the medical data to be detected;
异常标记模块40,用于若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。The abnormal marking module 40 is configured to mark the target medical data abnormally if there is target medical data satisfying abnormal characteristics in the medical data to be detected.
进一步地,所述医疗数据异常识别装置包括:Further, the medical data abnormality identification device includes:
所述分组模块20,还用于在所述预设维度为医院维度时,将所述待检测医疗数据按照病种进行分组,获得各病种对应的第一子集合;The grouping module 20 is further configured to group the medical data to be tested according to the disease type when the preset dimension is the hospital dimension, to obtain a first subset corresponding to each disease type;
第一计算模块,用于从各病种对应的第一子集合中,获取各病种的总住院次数和总住院天数,基于所述各病种的总住院次数和总住院天数计算获得各病种的平均单次住院天数;将所述各病种的平均单次住院天数与各病种对应的预设天数进行比较,获得各病种的平均单次住院天数与对应预设天数的天数差,计算各病种的所述天数差与对应预设天数的比值,得到各病种对应的天数异常因子;The first calculation module is used to obtain the total number of hospitalizations and the total number of hospitalization days of each disease type from the first subset corresponding to each disease type, and calculate and obtain each disease based on the total number of hospitalizations and the total number of hospitalization days of each disease type The average number of hospital stays per species; compare the average number of hospital stays for each disease with the preset days corresponding to each disease to obtain the difference between the average number of hospital stays for each disease and the number of days corresponding to the preset days , Calculate the ratio of the difference between the number of days of each disease type and the corresponding preset number of days to obtain the abnormal factor of the number of days corresponding to each disease type;
第一异常判定模块,用于在任一病种对应的天数异常因子大于第一预设阈值时,该病种对应的第一子集合满足异常特征。The first abnormality determination module is configured to: when the abnormality factor of the number of days corresponding to any disease type is greater than the first preset threshold, the first subset corresponding to the disease type meets the abnormality feature.
进一步地,所述医疗数据异常识别装置包括:Further, the medical data abnormality identification device includes:
第二计算模块,用于从各病种对应的第一子集合中,获取各病种的参保人数和总住院次数,基于各病种的参保人数和总住院次数计算获得各病种对应的每人平均住院次数;将各病种对应的每人平均住院次数与对应的预设次数进行比较,获得各病种的每人平均住院次数与对应预设次数的次数差,计算各病种的所述次数差与对应预设次数的比值,得到各病种对应的次数异常因子;The second calculation module is used to obtain the number of insured persons and the total number of hospitalizations of each disease type from the first sub-collection corresponding to each disease type, and calculate and obtain the correspondence of each disease type based on the number of insured persons of each disease type and the total number of hospitalizations The average number of hospitalizations per person for each patient; compare the average number of hospitalizations per person for each disease type with the corresponding preset number of times to obtain the difference between the average number of hospitalizations per person for each disease type and the corresponding preset number of times to calculate each disease type The ratio of the difference between the number of times and the corresponding preset number of times to obtain the abnormal factor of the number of times corresponding to each disease type;
第二异常判定模块,用于在任一病种对应的次数异常因子大于第二预设阈值时,该病种对应的第一子集合满足异常特征。The second abnormality determination module is configured to: when the abnormality factor of the number of times corresponding to any disease type is greater than the second preset threshold, the first subset corresponding to the disease type satisfies abnormal characteristics.
进一步地,所述医疗数据异常识别装置包括:Further, the medical data abnormality identification device includes:
第三计算模块,用于从各病种对应的第一子集合中,获取各病种的总住院次数和总住院金额,基于所述各病种的总住院次数和总住院金额计算获得各病种的平均单次住院金额;将所述各病种的平均单次住院金额与对应的预设金额进行比较,获得各病种的平均单次住院金额与对应预设金额的金额差,计算各病种的所述金额差与对应预设金额的比值,得到各病种对应的金额异常因子;The third calculation module is used to obtain the total number of hospitalizations and total hospitalization amount of each disease type from the first subset corresponding to each disease type, and calculate and obtain each disease based on the total number of hospitalizations and total hospitalization amount of each disease type The average single hospitalization amount of each kind; compare the average single hospitalization amount of each disease with the corresponding preset amount to obtain the difference between the average single hospitalization amount of each disease and the corresponding preset amount, and calculate each The ratio of the amount difference of the disease type to the corresponding preset amount to obtain the amount abnormality factor corresponding to each disease type;
第三异常判定模块,用于在任一病种对应的金额异常因子大于第三预设阈值时,该病种对应的第一子集合满足异常特征。The third abnormality determination module is configured to: when the amount abnormality factor corresponding to any disease type is greater than the third preset threshold, the first subset corresponding to the disease type meets abnormal characteristics.
进一步地,所述医疗数据异常识别装置包括:Further, the medical data abnormality identification device includes:
所述分组模块20,还用于在所述预设维度为个人维度时,根据参保人将所述待检测医疗数据进行分组,获得各参保人对应的第二子集合;The grouping module 20 is further configured to group the medical data to be tested according to the insured persons when the preset dimension is an individual dimension to obtain a second subset corresponding to each insured person;
第四计算模块,用于提取所述第二子集合中每条医疗数据对应的就诊时间,计算获得所述第二子集合中相邻医疗数据的相邻就诊间隔;获取预设的时间间隔阈值,计算所述相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述第二子集合中每条医疗数据对应的间隔异常因子;The fourth calculation module is used for extracting the consultation time corresponding to each piece of medical data in the second subset, calculating the adjacent consultation interval for obtaining the adjacent medical data in the second subset; obtaining the preset time interval threshold Calculate the time difference between the adjacent consultation interval and the time interval threshold, calculate the ratio of the time difference and the time interval threshold to obtain the interval abnormality factor corresponding to each piece of medical data in the second subset;
第四异常判定模块,用于在所述第二子集合中的医疗数据对应的间隔异常因子大于第四预设阈值时,该医疗数据满足异常特征。The fourth abnormality determination module is configured to: when the interval abnormality factor corresponding to the medical data in the second subset is greater than the fourth preset threshold, the medical data meets the abnormality feature.
进一步地,所述医疗数据异常识别装置包括:Further, the medical data abnormality identification device includes:
相似判断模块,用于提取所述第二子集合中每条医疗数据对应的诊断结果,判断所述第二子集合中是否存在对应相似诊断结果的相邻医疗数据;The similarity judgment module is used to extract the diagnosis result corresponding to each piece of medical data in the second subset and determine whether there is adjacent medical data corresponding to the similar diagnosis result in the second subset;
第一获取模块,用于若所述第二子集合中存在对应相似诊断结果的相邻医疗数据,则获取所述相邻医疗数据的相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述相邻医疗数据对应的间隔异常因子;The first obtaining module is used to obtain the time difference between the adjacent medical visit interval of the adjacent medical data and the time interval threshold if there is adjacent medical data corresponding to similar diagnosis results in the second subset The ratio of the time difference to the time interval threshold to obtain an interval anomaly factor corresponding to the adjacent medical data;
第五异常判定模块,用于在所述相邻医疗数据对应的间隔异常因子大于第五预设阈值时,该医疗数据满足异常特征。The fifth abnormality determination module is configured to: when the interval abnormality factor corresponding to the adjacent medical data is greater than a fifth preset threshold, the medical data meets abnormal characteristics.
进一步地,所述医疗数据异常识别装置包括:Further, the medical data abnormality identification device includes:
第五计算模块,用于提取所述第二子集合中每条医疗数据对应的诊疗项目,将相邻就诊各自对应的诊疗项目与参考诊疗项目集合分别进行对比,获得相邻就诊各自对应的诊疗项目与参考诊疗项目集合的重合比例,并计算所有相邻就诊的平均重合比例,得到相邻就诊的诊疗项目的连续度;The fifth calculation module is used for extracting the diagnosis and treatment items corresponding to each piece of medical data in the second sub-collection, respectively comparing the diagnosis and treatment items corresponding to the adjacent treatments with the reference diagnosis and treatment item set, and obtaining the corresponding treatments for the adjacent treatments The coincidence ratio of the item and the reference diagnosis and treatment item set, and calculate the average coincidence ratio of all adjacent consultations to obtain the continuity of the adjacent treatment items;
第六异常判定模块,用于在所述连续度大于第六预设阈值时,对应的医疗数据满足异常特征。 The sixth abnormality determination module is configured to: when the continuity is greater than the sixth preset threshold, the corresponding medical data meets abnormal characteristics.
本申请还提出一种计算机可读存储介质,其上存储有计算机可读指令。计算机可读存储介质可以为非易失性可读存储介质。所述计算机可读存储介质可以是图1的医疗数据异常识别终端中的存储器201,也可以是如ROM(Read-Only Memory,只读存储器)/RAM(Random Access Memory,随机存取存储器)、磁碟、光盘中的至少一种,所述计算机可读存储介质包括若干指令用以使得一台具有处理器的终端设备(可以是手机,计算机,服务器,网络设备或本申请实施例中的医疗数据异常识别终端等)执行本申请各个实施例所述的方法。The present application also proposes a computer-readable storage medium on which computer-readable instructions are stored. The computer-readable storage medium may be a non-volatile readable storage medium. The computer-readable storage medium may be the memory 201 in the medical data abnormality recognition terminal of FIG. 1, or may be a ROM (Read-Only Memory, read-only memory) / RAM (Random Access Memory (random access memory), at least one of magnetic disks and optical disks, the computer-readable storage medium includes several instructions to make a terminal device (which may be a mobile phone, computer, server, network device) with a processor Or the medical data abnormality identification terminal in the embodiments of the present application, etc.) execute the methods described in the embodiments of the present application.
需要说明的是,在本文中,术语“包括”、“包含”或者其任何其他变体意在涵盖非排他性的包含,从而使得包括一系列要素的过程、方法、物品或者服务端不仅包括那些要素,而且包括没有明确列出的其他要素,或者是包括为这种过程、方法、物品或者服务端所固有的要素。在没有更多限制的情况下,由语句“包括一个……”限定的要素,并不排除在包括该要素的过程、方法、物品或者服务端中还存在另外的相同要素。It should be noted that in this article, the terms "include", "include" or any other variant thereof are intended to cover non-exclusive inclusion, so that a process, method, article or service that includes a series of elements includes not only those elements , And include other elements not explicitly listed, or include elements inherent to this process, method, item, or service. Without more restrictions, the element defined by the sentence "include one ..." does not exclude that there are other identical elements in the process, method, article, or server that includes the element.
上述本申请实施例序号仅仅为了描述,不代表实施例的优劣。The sequence numbers of the above embodiments of the present application are for description only, and do not represent the advantages and disadvantages of the embodiments.
通过以上的实施方式的描述,本领域的技术人员可以清楚地了解到上述实施例方法可借助软件加必需的通用硬件平台的方式来实现,当然也可以通过硬件,但很多情况下前者是更佳的实施方式。Through the description of the above embodiments, those skilled in the art can clearly understand that the methods in the above embodiments can be implemented by means of software plus a necessary general hardware platform, and of course, can also be implemented by hardware, but in many cases the former is better Implementation.
以上仅为本申请的优选实施例,并非因此限制本申请的专利范围,凡是利用本申请说明书及附图内容所作的等效结构或等效流程变换,或直接或间接运用在其他相关的技术领域,均同理包括在本申请的专利保护范围内。The above are only the preferred embodiments of the present application, and do not limit the patent scope of the present application. Any equivalent structure or equivalent process transformation made by the description and drawings of this application, or directly or indirectly used in other related technical fields , The same reason is included in the scope of patent protection of this application.

Claims (20)

  1. 一种医疗数据异常识别方法,其特征在于,所述医疗数据异常识别方法包括以下步骤: A medical data abnormality identification method, characterized in that the medical data abnormality identification method includes the following steps:
    在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;When an abnormality detection request is detected, the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained;
    根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;Group the medical data to be tested according to a preset dimension to obtain a grouped subset;
    基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;Analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected;
    若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。If there is target medical data satisfying abnormal characteristics in the medical data to be detected, the target medical data is marked abnormally.
  2. 如权利要求1所述的医疗数据异常识别方法,其特征在于,在所述预设维度为医院维度时,所述根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合的步骤包括:The medical data abnormality identification method according to claim 1, wherein when the preset dimension is a hospital dimension, the medical data to be detected is grouped according to the preset dimension to obtain a grouped subset The steps include:
    将所述待检测医疗数据按照病种进行分组,获得各病种对应的第一子集合;Grouping the medical data to be detected according to disease types to obtain a first subset corresponding to each disease type;
    所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括: The step of analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected includes: The
    从各病种对应的第一子集合中,获取各病种的总住院次数和总住院天数,基于所述各病种的总住院次数和总住院天数计算获得各病种的平均单次住院天数;From the first sub-collection corresponding to each disease type, obtain the total number of hospitalizations and the total number of hospitalization days of each disease type, and calculate the average number of single hospitalization days of each disease type based on the total number of hospitalizations and total hospitalization days of each disease type ;
    将所述各病种的平均单次住院天数与各病种对应的预设天数进行比较,获得各病种的平均单次住院天数与对应预设天数的天数差,计算各病种的所述天数差与对应预设天数的比值,得到各病种对应的天数异常因子;Compare the average number of days of each hospitalization with the preset days corresponding to each disease type to obtain the difference between the average number of days of each hospitalization and the number of days corresponding to the preset number of days, and calculate the The ratio of the difference between the number of days and the corresponding preset number of days to obtain the abnormal factor of the number of days corresponding to each disease type;
    在任一病种对应的天数异常因子大于第一预设阈值时,该病种对应的第一子集合满足异常特征。When the abnormality factor for the number of days corresponding to any disease type is greater than the first preset threshold, the first subset corresponding to the disease type satisfies the abnormality feature.
  3. 如权利要求2所述的医疗数据异常识别方法,其特征在于,所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括:The medical data abnormality identification method according to claim 2, wherein each of the subsets is analyzed based on a preset rule corresponding to a preset dimension to determine whether there is a target satisfying the abnormal feature in the medical data to be detected The steps of medical data include:
    从各病种对应的第一子集合中,获取各病种的参保人数和总住院次数,基于各病种的参保人数和总住院次数计算获得各病种对应的每人平均住院次数;From the first sub-collection corresponding to each disease type, obtain the number of insured persons and the total number of hospitalizations of each disease type, and calculate the average number of hospitalizations per person corresponding to each disease type based on the number of insured persons of each disease type and the total number of hospitalizations;
    将各病种对应的每人平均住院次数与对应的预设次数进行比较,获得各病种的每人平均住院次数与对应预设次数的次数差,计算各病种的所述次数差与对应预设次数的比值,得到各病种对应的次数异常因子;Compare the average number of hospitalizations per person for each disease type with the corresponding preset number of times to obtain the difference between the number of average hospitalizations per person for each disease type and the corresponding preset number of times, and calculate the difference between the number of times for each disease type and the corresponding The ratio of the preset number of times to obtain the abnormal factor of the number of times corresponding to each disease type;
    在任一病种对应的次数异常因子大于第二预设阈值时,该病种对应的第一子集合满足异常特征。When the abnormality factor of the number of times corresponding to any disease type is greater than the second preset threshold, the first subset corresponding to the disease type meets the abnormal characteristics.
  4. 如权利要求2所述的医疗数据异常识别方法,其特征在于,所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括:The medical data abnormality identification method according to claim 2, wherein each of the subsets is analyzed based on a preset rule corresponding to a preset dimension to determine whether there is a target satisfying the abnormal feature in the medical data to be detected The steps of medical data include:
    从各病种对应的第一子集合中,获取各病种的总住院次数和总住院金额,基于所述各病种的总住院次数和总住院金额计算获得各病种的平均单次住院金额;From the first sub-collection corresponding to each disease type, obtain the total number of hospitalizations and total hospitalization amount of each disease type, and calculate the average single hospitalization amount of each disease type based on the total number of hospitalizations and total hospitalization amount of each disease type ;
    将所述各病种的平均单次住院金额与对应的预设金额进行比较,获得各病种的平均单次住院金额与对应预设金额的金额差,计算各病种的所述金额差与对应预设金额的比值,得到各病种对应的金额异常因子;Compare the average single hospitalization amount of each disease type with the corresponding preset amount, obtain the difference between the average single hospitalization amount of each disease type and the corresponding preset amount, and calculate the amount difference and Corresponding to the ratio of the preset amount, the amount abnormality factor corresponding to each disease type is obtained;
    在任一病种对应的金额异常因子大于第三预设阈值时,该病种对应的第一子集合满足异常特征。When the amount abnormality factor corresponding to any disease type is greater than the third preset threshold, the first subset corresponding to the disease type meets the abnormal characteristics.
  5. 如权利要求1所述的医疗数据异常识别方法,其特征在于,在所述预设维度为个人维度时,所述根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合的步骤包括:The medical data abnormality identification method according to claim 1, wherein when the preset dimension is a personal dimension, the medical data to be detected is grouped according to the preset dimension to obtain a grouped subset The steps include:
    根据参保人将所述待检测医疗数据进行分组,获得各参保人对应的第二子集合;Group the medical data to be tested according to the insured persons to obtain a second sub-set corresponding to each insured person;
    所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括:The step of analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected includes:
    提取所述第二子集合中每条医疗数据对应的就诊时间,计算获得所述第二子集合中相邻医疗数据的相邻就诊间隔;Extracting the consultation time corresponding to each piece of medical data in the second sub-set, and calculating the adjacent consultation interval of the adjacent medical data in the second sub-set;
    获取预设的时间间隔阈值,计算所述相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述第二子集合中每条医疗数据对应的间隔异常因子;Obtain a preset time interval threshold, calculate the time difference between the adjacent visit interval and the time interval threshold, calculate the ratio of the time difference to the time interval threshold, and obtain each medical data correspondence in the second subset The interval anomaly factor;
    在所述第二子集合中的医疗数据对应的间隔异常因子大于第四预设阈值时,该医疗数据满足异常特征。When the interval abnormality factor corresponding to the medical data in the second subset is greater than the fourth preset threshold, the medical data satisfies the abnormality feature.
  6. 如权利要求5所述的医疗数据异常识别方法,其特征在于,所述获取预设的时间间隔阈值,计算所述相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述第二子集合中每条医疗数据对应的间隔异常因子的步骤之后包括:The medical data abnormality identification method according to claim 5, wherein the acquiring a preset time interval threshold value, calculating the time difference between the adjacent visit interval and the time interval threshold value, calculating the time difference and the The ratio of the time interval threshold to obtain the interval anomaly factor corresponding to each piece of medical data in the second subset includes:
    提取所述第二子集合中每条医疗数据对应的诊断结果,判断所述第二子集合中是否存在对应相似诊断结果的相邻医疗数据;Extracting the diagnosis result corresponding to each piece of medical data in the second subset, and judging whether there is adjacent medical data corresponding to similar diagnosis results in the second subset;
    若所述第二子集合中存在对应相似诊断结果的相邻医疗数据,则获取所述相邻医疗数据的相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述相邻医疗数据对应的间隔异常因子;If there is adjacent medical data corresponding to a similar diagnosis result in the second subset, the time difference between the adjacent medical interval of the adjacent medical data and the time interval threshold is obtained, and the time difference and the time interval are calculated The ratio of the threshold to obtain the interval anomaly factor corresponding to the adjacent medical data;
    在所述相邻医疗数据对应的间隔异常因子大于第五预设阈值时,该医疗数据满足异常特征。When the interval anomaly factor corresponding to the adjacent medical data is greater than the fifth preset threshold, the medical data meets the anomaly characteristics.
  7. 如权利要求5所述的医疗数据异常识别方法,其特征在于,所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括:The medical data abnormality identification method according to claim 5, wherein each of the subsets is analyzed based on a preset rule corresponding to a preset dimension to determine whether there is a target satisfying the abnormal feature in the medical data to be detected The steps of medical data include:
    提取所述第二子集合中每条医疗数据对应的诊疗项目,将相邻就诊各自对应的诊疗项目与参考诊疗项目集合分别进行对比,获得相邻就诊各自对应的诊疗项目与参考诊疗项目集合的重合比例,并计算所有相邻就诊的平均重合比例,得到相邻就诊的诊疗项目的连续度;Extracting the diagnosis and treatment items corresponding to each piece of medical data in the second sub-collection, comparing the corresponding diagnosis and treatment items of the adjacent treatments with the reference diagnosis and treatment item sets respectively, and obtaining the corresponding diagnosis and treatment items of the adjacent diagnosis and reference treatment item sets The coincidence ratio, and calculate the average coincidence ratio of all adjacent visits to obtain the continuity of the adjacent treatment items;
    在所述连续度大于第六预设阈值时,对应的医疗数据满足异常特征。 When the continuity is greater than the sixth preset threshold, the corresponding medical data meets abnormal characteristics.
  8. 一种医疗数据异常识别装置,其特征在于,所述医疗数据异常识别装置包括:A medical data abnormality identification device, characterized in that the medical data abnormality identification device includes:
    获取模块,用于在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;An obtaining module, configured to obtain the target hospital corresponding to the abnormal detection request and the medical data to be detected of the target hospital when the abnormal detection request is detected;
    分组模块,用于根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;A grouping module, configured to group the medical data to be detected according to a preset dimension to obtain a grouped subset;
    异常分析模块,用于基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;An anomaly analysis module, configured to analyze each of the subsets based on a preset rule corresponding to a preset dimension, and determine whether there is target medical data satisfying an abnormal feature in the medical data to be detected;
    异常标记模块,用于若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。The abnormal marking module is configured to mark the target medical data abnormally if there is target medical data satisfying abnormal characteristics in the medical data to be detected.
  9. 如权利要求8所述的医疗数据异常识别装置,其特征在于,所述分组模块,还用于在所述预设维度为医院维度时,将所述待检测医疗数据按照病种进行分组,获得各病种对应的第一子集合;The medical data abnormality recognition device according to claim 8, wherein the grouping module is further configured to group the medical data to be detected according to the disease type when the preset dimension is a hospital dimension to obtain The first sub-collection corresponding to each disease type;
    所述分组模块包括:The grouping module includes:
    第一计算模块,用于从各病种对应的第一子集合中,获取各病种的总住院次数和总住院天数,基于所述各病种的总住院次数和总住院天数计算获得各病种的平均单次住院天数;将所述各病种的平均单次住院天数与各病种对应的预设天数进行比较,获得各病种的平均单次住院天数与对应预设天数的天数差,计算各病种的所述天数差与对应预设天数的比值,得到各病种对应的天数异常因子;The first calculation module is used to obtain the total number of hospitalizations and the total number of hospitalization days of each disease type from the first subset corresponding to each disease type, and calculate and obtain each disease based on the total number of hospitalizations and the total number of hospitalization days of each disease type The average number of hospital stays per species; compare the average number of hospital stays for each disease with the preset days corresponding to each disease to obtain the difference between the average number of hospital stays for each disease and the number of days corresponding to the preset days , Calculate the ratio of the difference between the number of days of each disease type and the corresponding preset number of days to obtain the abnormal factor of the number of days corresponding to each disease type;
    第一异常判定模块,用于在任一病种对应的天数异常因子大于第一预设阈值时,该病种对应的第一子集合满足异常特征。The first abnormality determination module is configured to: when the abnormality factor of the number of days corresponding to any disease type is greater than the first preset threshold, the first subset corresponding to the disease type meets the abnormality feature.
  10. 如权利要求9所述的医疗数据异常识别装置,其特征在于,所述异常分析模块包括:The medical data abnormality identification device according to claim 9, wherein the abnormality analysis module comprises:
    第二计算模块,用于从各病种对应的第一子集合中,获取各病种的参保人数和总住院次数,基于各病种的参保人数和总住院次数计算获得各病种对应的每人平均住院次数;将各病种对应的每人平均住院次数与对应的预设次数进行比较,获得各病种的每人平均住院次数与对应预设次数的次数差,计算各病种的所述次数差与对应预设次数的比值,得到各病种对应的次数异常因子;The second calculation module is used to obtain the number of insured persons and the total number of hospitalizations of each disease type from the first sub-collection corresponding to each disease type, and calculate and obtain the correspondence of each disease type based on the number of insured persons of each disease type and the total number of hospitalizations The average number of hospitalizations per person for each patient; compare the average number of hospitalizations per person for each disease type with the corresponding preset number of times to obtain the difference between the average number of hospitalizations per person for each disease type and the corresponding preset number of times to calculate each disease type The ratio of the difference between the number of times and the corresponding preset number of times to obtain the abnormal factor of the number of times corresponding to each disease type;
    第二异常判定模块,用于在任一病种对应的次数异常因子大于第二预设阈值时,该病种对应的第一子集合满足异常特征。The second abnormality determination module is configured to: when the abnormality factor of the number of times corresponding to any disease type is greater than the second preset threshold, the first subset corresponding to the disease type satisfies abnormal characteristics.
  11. 如权利要求9所述的医疗数据异常识别装置,其特征在于,所述异常分析模块包括:The medical data abnormality identification device according to claim 9, wherein the abnormality analysis module comprises:
    第三计算模块,用于从各病种对应的第一子集合中,获取各病种的总住院次数和总住院金额,基于所述各病种的总住院次数和总住院金额计算获得各病种的平均单次住院金额;将所述各病种的平均单次住院金额与对应的预设金额进行比较,获得各病种的平均单次住院金额与对应预设金额的金额差,计算各病种的所述金额差与对应预设金额的比值,得到各病种对应的金额异常因子;The third calculation module is used to obtain the total number of hospitalizations and total hospitalization amount of each disease type from the first subset corresponding to each disease type, and calculate and obtain each disease based on the total number of hospitalizations and total hospitalization amount of each disease type The average single hospitalization amount of each kind; compare the average single hospitalization amount of each disease with the corresponding preset amount to obtain the difference between the average single hospitalization amount of each disease and the corresponding preset amount, and calculate each The ratio of the amount difference of the disease type to the corresponding preset amount to obtain the amount abnormality factor corresponding to each disease type;
    第三异常判定模块,用于在任一病种对应的金额异常因子大于第三预设阈值时,该病种对应的第一子集合满足异常特征。The third abnormality determination module is configured to: when the amount abnormality factor corresponding to any disease type is greater than the third preset threshold, the first subset corresponding to the disease type meets abnormal characteristics.
  12. 如权利要求8所述的医疗数据异常识别装置,其特征在于,所述分组模块,还用于在所述预设维度为个人维度时,根据参保人将所述待检测医疗数据进行分组,获得各参保人对应的第二子集合;The medical data abnormality identification device according to claim 8, wherein the grouping module is further configured to group the medical data to be detected according to the insured person when the preset dimension is an individual dimension, Obtain the second sub-collection corresponding to each participant;
    所述分组模块包括:The grouping module includes:
    第四计算模块,用于提取所述第二子集合中每条医疗数据对应的就诊时间,计算获得所述第二子集合中相邻医疗数据的相邻就诊间隔;获取预设的时间间隔阈值,计算所述相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述第二子集合中每条医疗数据对应的间隔异常因子;The fourth calculation module is used for extracting the consultation time corresponding to each piece of medical data in the second subset, calculating the adjacent consultation interval for obtaining the adjacent medical data in the second subset; obtaining the preset time interval threshold Calculate the time difference between the adjacent consultation interval and the time interval threshold, calculate the ratio of the time difference and the time interval threshold to obtain the interval abnormality factor corresponding to each piece of medical data in the second subset;
    第四异常判定模块,用于在所述第二子集合中的医疗数据对应的间隔异常因子大于第四预设阈值时,该医疗数据满足异常特征。The fourth abnormality determination module is configured to: when the interval abnormality factor corresponding to the medical data in the second subset is greater than the fourth preset threshold, the medical data meets the abnormality feature.
  13. 如权利要求12所述的医疗数据异常识别装置,其特征在于,所述分组模块还包括:The medical data abnormality identification device according to claim 12, wherein the grouping module further comprises:
    相似判断模块,用于提取所述第二子集合中每条医疗数据对应的诊断结果,判断所述第二子集合中是否存在对应相似诊断结果的相邻医疗数据;The similarity judgment module is used to extract the diagnosis result corresponding to each piece of medical data in the second subset and determine whether there is adjacent medical data corresponding to the similar diagnosis result in the second subset;
    第一获取模块,用于若所述第二子集合中存在对应相似诊断结果的相邻医疗数据,则获取所述相邻医疗数据的相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述相邻医疗数据对应的间隔异常因子;The first obtaining module is used to obtain the time difference between the adjacent medical visit interval of the adjacent medical data and the time interval threshold if there is adjacent medical data corresponding to similar diagnosis results in the second subset The ratio of the time difference to the time interval threshold to obtain an interval anomaly factor corresponding to the adjacent medical data;
    第五异常判定模块,用于在所述相邻医疗数据对应的间隔异常因子大于第五预设阈值时,该医疗数据满足异常特征。The fifth abnormality determination module is configured to: when the interval abnormality factor corresponding to the adjacent medical data is greater than a fifth preset threshold, the medical data meets abnormal characteristics.
  14. 如权利要求12所述的医疗数据异常识别装置,其特征在于,所述分组模块包括:The medical data abnormality identification device according to claim 12, wherein the grouping module comprises:
    第五计算模块,用于提取所述第二子集合中每条医疗数据对应的诊疗项目,将相邻就诊各自对应的诊疗项目与参考诊疗项目集合分别进行对比,获得相邻就诊各自对应的诊疗项目与参考诊疗项目集合的重合比例,并计算所有相邻就诊的平均重合比例,得到相邻就诊的诊疗项目的连续度;The fifth calculation module is used for extracting the diagnosis and treatment items corresponding to each piece of medical data in the second sub-collection, respectively comparing the diagnosis and treatment items corresponding to the adjacent treatments with the reference diagnosis and treatment item set, and obtaining the corresponding treatments for the adjacent treatments The coincidence ratio of the item and the reference diagnosis and treatment item set, and calculate the average coincidence ratio of all adjacent consultations to obtain the continuity of the adjacent treatment items;
    第六异常判定模块,用于在所述连续度大于第六预设阈值时,对应的医疗数据满足异常特征。The sixth abnormality determination module is configured to: when the continuity is greater than the sixth preset threshold, the corresponding medical data meets abnormal characteristics.
  15. 一种医疗数据异常识别终端,其特征在于,所述医疗数据异常识别终端包括处理器、存储器、以及存储在所述存储器上并可被所述处理器执行的计算机可读指令,其中所述计算机可读指令被所述处理器执行时,实现如下的步骤:A medical data abnormality identification terminal, characterized in that the medical data abnormality identification terminal includes a processor, a memory, and computer readable instructions stored on the memory and executable by the processor, wherein the computer When the readable instructions are executed by the processor, the following steps are implemented:
    在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;When an abnormality detection request is detected, the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained;
    根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;Group the medical data to be tested according to a preset dimension to obtain a grouped subset;
    基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;Analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected;
    若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。If there is target medical data satisfying abnormal characteristics in the medical data to be detected, the target medical data is marked abnormally.
  16. 如权利要求15所述的医疗数据异常识别终端,其特征在于,在所述预设维度为医院维度时,所述根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合的步骤包括:The medical data abnormality recognition terminal according to claim 15, wherein when the preset dimension is a hospital dimension, the medical data to be detected is grouped according to the preset dimension to obtain a grouped subset The steps include:
    将所述待检测医疗数据按照病种进行分组,获得各病种对应的第一子集合;Grouping the medical data to be detected according to disease types to obtain a first subset corresponding to each disease type;
    所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括: The step of analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected includes: The
    从各病种对应的第一子集合中,获取各病种的总住院次数和总住院天数,基于所述各病种的总住院次数和总住院天数计算获得各病种的平均单次住院天数;From the first sub-collection corresponding to each disease type, obtain the total number of hospitalizations and the total number of hospitalization days of each disease type, and calculate the average number of single hospitalization days of each disease type based on the total number of hospitalizations and total hospitalization days of each disease type ;
    将所述各病种的平均单次住院天数与各病种对应的预设天数进行比较,获得各病种的平均单次住院天数与对应预设天数的天数差,计算各病种的所述天数差与对应预设天数的比值,得到各病种对应的天数异常因子;Compare the average number of days of each hospitalization with the preset days corresponding to each disease type to obtain the difference between the average number of days of each hospitalization and the number of days corresponding to the preset number of days, and calculate the The ratio of the difference between the number of days and the corresponding preset number of days to obtain the abnormal factor of the number of days corresponding to each disease type;
    在任一病种对应的天数异常因子大于第一预设阈值时,该病种对应的第一子集合满足异常特征。When the abnormality factor for the number of days corresponding to any disease type is greater than the first preset threshold, the first subset corresponding to the disease type satisfies the abnormality feature.
  17. 如权利要求15所述的医疗数据异常识别终端,其特征在于,在所述预设维度为个人维度时,所述根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合的步骤包括:The medical data abnormality identification terminal according to claim 15, wherein when the preset dimension is a personal dimension, the medical data to be detected is grouped according to the preset dimension to obtain a grouped subset The steps include:
    根据参保人将所述待检测医疗数据进行分组,获得各参保人对应的第二子集合;Group the medical data to be tested according to the insured persons to obtain a second sub-set corresponding to each insured person;
    所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括:The step of analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected includes:
    提取所述第二子集合中每条医疗数据对应的就诊时间,计算获得所述第二子集合中相邻医疗数据的相邻就诊间隔;Extracting the consultation time corresponding to each piece of medical data in the second sub-set, and calculating the adjacent consultation interval of the adjacent medical data in the second sub-set;
    获取预设的时间间隔阈值,计算所述相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述第二子集合中每条医疗数据对应的间隔异常因子;Obtain a preset time interval threshold, calculate the time difference between the adjacent visit interval and the time interval threshold, calculate the ratio of the time difference to the time interval threshold, and obtain each medical data correspondence in the second subset The interval anomaly factor;
    在所述第二子集合中的医疗数据对应的间隔异常因子大于第四预设阈值时,该医疗数据满足异常特征。When the interval abnormality factor corresponding to the medical data in the second subset is greater than the fourth preset threshold, the medical data satisfies the abnormality feature.
  18. 一种计算机可读存储介质,其特征在于,所述计算机可读存储介质上存储有医疗数据异常识别计算机可读指令,其中所述计算机可读指令被处理器执行时,实现如下步骤:A computer-readable storage medium, characterized in that computer-readable instructions for medical data abnormality recognition are stored on the computer-readable storage medium, and when the computer-readable instructions are executed by a processor, the following steps are implemented:
    在检测到异常检测请求时,获取该异常检测请求对应的目标医院和所述目标医院的待检测医疗数据;When an abnormality detection request is detected, the target hospital corresponding to the abnormality detection request and the medical data to be detected of the target hospital are obtained;
    根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合;Group the medical data to be tested according to a preset dimension to obtain a grouped subset;
    基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据;Analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected;
    若所述待检测医疗数据中存在满足异常特征的目标医疗数据,则将所述目标医疗数据进行异常标记。If there is target medical data satisfying abnormal characteristics in the medical data to be detected, the target medical data is marked abnormally.
  19. 如权利要求18所述的计算机可读存储介质,其特征在于,在所述预设维度为医院维度时,所述根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合的步骤包括:The computer-readable storage medium of claim 18, wherein when the preset dimension is a hospital dimension, the medical data to be tested is grouped according to the preset dimension to obtain a grouped subset The steps include:
    将所述待检测医疗数据按照病种进行分组,获得各病种对应的第一子集合;Grouping the medical data to be detected according to disease types to obtain a first subset corresponding to each disease type;
    所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括: The step of analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected includes: The
    从各病种对应的第一子集合中,获取各病种的总住院次数和总住院天数,基于所述各病种的总住院次数和总住院天数计算获得各病种的平均单次住院天数;From the first sub-collection corresponding to each disease type, obtain the total number of hospitalizations and the total number of hospitalization days of each disease type, and calculate the average number of single hospitalization days of each disease type based on the total number of hospitalizations and total hospitalization days of each disease type ;
    将所述各病种的平均单次住院天数与各病种对应的预设天数进行比较,获得各病种的平均单次住院天数与对应预设天数的天数差,计算各病种的所述天数差与对应预设天数的比值,得到各病种对应的天数异常因子;Compare the average number of days of each hospitalization with the preset days corresponding to each disease type to obtain the difference between the average number of days of each hospitalization and the number of days corresponding to the preset number of days, and calculate the The ratio of the difference between the number of days and the corresponding preset number of days to obtain the abnormal factor of the number of days corresponding to each disease type;
    在任一病种对应的天数异常因子大于第一预设阈值时,该病种对应的第一子集合满足异常特征。When the abnormality factor for the number of days corresponding to any disease type is greater than the first preset threshold, the first subset corresponding to the disease type satisfies the abnormality feature.
  20. 如权利要求18所述的计算机可读存储介质,其特征在于,在所述预设维度为个人维度时,所述根据预设维度将所述待检测医疗数据进行分组,获得分组后的子集合的步骤包括:The computer-readable storage medium of claim 18, wherein when the preset dimension is a personal dimension, the medical data to be tested is grouped according to the preset dimension to obtain a grouped subset The steps include:
    根据参保人将所述待检测医疗数据进行分组,获得各参保人对应的第二子集合;Group the medical data to be tested according to the insured persons to obtain a second sub-set corresponding to each insured person;
    所述基于预设维度对应的预设规则分析各所述子集合,判断所述待检测医疗数据中是否存在满足异常特征的目标医疗数据的步骤包括:The step of analyzing each of the subsets based on a preset rule corresponding to a preset dimension to determine whether there is target medical data satisfying abnormal characteristics in the medical data to be detected includes:
    提取所述第二子集合中每条医疗数据对应的就诊时间,计算获得所述第二子集合中相邻医疗数据的相邻就诊间隔;Extracting the consultation time corresponding to each piece of medical data in the second sub-set, and calculating the adjacent consultation interval of the adjacent medical data in the second sub-set;
    获取预设的时间间隔阈值,计算所述相邻就诊间隔与所述时间间隔阈值的时间差,计算所述时间差与所述时间间隔阈值的比值,得到所述第二子集合中每条医疗数据对应的间隔异常因子;Obtain a preset time interval threshold, calculate the time difference between the adjacent visit interval and the time interval threshold, calculate the ratio of the time difference to the time interval threshold, and obtain each medical data correspondence in the second subset The interval anomaly factor;
    在所述第二子集合中的医疗数据对应的间隔异常因子大于第四预设阈值时,该医疗数据满足异常特征。 When the interval abnormality factor corresponding to the medical data in the second subset is greater than the fourth preset threshold, the medical data satisfies the abnormality feature.
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