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데이터마이닝 기법을 이용한 효율적인 DRG 확인심사대상건 검색방법
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  • 데이터마이닝 기법을 이용한 효율적인 DRG 확인심사대상건 검색방법
저자명
이중규,조민우,박기동,이무송,이상일,김창엽,김용익,홍두호,Lee. Jung-Kyu,Jo. Min-Woo,Park. Ki-Dong,Lee. Moo-Song,Lee. Sang-Il,Kim. Chang-Yup,Kim. Yong-Ik,H
간행물명
예방의학회지
권/호정보
2003년|36권 2호|pp.147-152 (6 pages)
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대한예방의학회
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기타
이 논문은 한국과학기술정보연구원과 논문 연계를 통해 무료로 제공되는 원문입니다.
서지반출

기타언어초록

Objectives : To develop a Diagnosis-Related Group (DRG) fraud candidate detection method, using data mining techniques, and to examine the efficiency of the developed method. Methods ; The Study included 79,790 DRGs and their related claims of 8 disease groups (Lens procedures, with or without, vitrectomy, tonsillectomy and/or adenoidectomy only, appendectomy, Cesarean section, vaginal delivery, anal and/or perianal procedures, inguinal and/or femoral hernia procedures, uterine and/or adnexa procedures for nonmalignancy), which were examined manually during a 32 months period. To construct an optimal prediction model, 38 variables were applied, and the correction rate and lift value of 3 models (decision tree, logistic regression, neural network) compared. The analyses were peformed separately by disease group. Results : The correction rates of the developed method, using data mining techniques, were 15.4 to 81.9%, according to disease groups, with an overall correction rate of 60.7%. The lift values were 1.9 to 7.3 according to disease groups, with an overall lift value of 4.1. Conclusions : The above findings suggested that the applying of data mining techniques is necessary to improve the efficiency of DRG fraud candidate detection.