Regression tree construction by bootstrap: model search for DRG-systems applied to Austrian health-data.

BMC Medical Informatics and Decision Making
Thomas GrubingerKarl-Peter Pfeiffer

Abstract

DRG-systems are used to allocate resources fairly to hospitals based on their performance. Statistically, this allocation is based on simple rules that can be modeled with regression trees. However, the resulting models often have to be adjusted manually to be medically reasonable and ethical. Despite the possibility of manual, performance degenerating adaptations of the original model, alternative trees are systematically searched. The bootstrap-based method bumping is used to build diverse and accurate regression tree models for DRG-systems. A two-step model selection approach is proposed. First, a reasonable model complexity is chosen, based on statistical, medical and economical considerations. Second, a medically meaningful and accurate model is selected. An analysis of 8 data-sets from Austrian DRG-data is conducted and evaluated based on the possibility to produce diverse and accurate models for predefined tree complexities. The best bootstrap-based trees offer increased predictive accuracy compared to the trees built by the CART algorithm. The analysis demonstrates that even for very small tree sizes, diverse models can be constructed being equally or even more accurate than the single model built by the standard CART a...Continue Reading

References

Apr 16, 1999·Statistics in Medicine·W D Shannon, D Banks
Aug 16, 2000·Deutsche medizinische Wochenschrift·M Lüngen, K W Lauterbach
Dec 15, 2006·Health Policy·Engelbert Theurl, Hannes Winner
Aug 19, 2007·BMC Medical Informatics and Decision Making·Haiwen Shi, James Lyons-Weiler
Jan 30, 2008·BMC Medical Informatics and Decision Making·Jeffrey S BarrettSundararajan Vijayakumar
Jan 16, 2009·BMC Medical Informatics and Decision Making·Soo-Yeon JiKayvan Najarian

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Citations

Dec 3, 2013·BMC Medical Informatics and Decision Making·Nicolas JayCatherine Quantin
May 26, 2017·Health Services Management Research : an Official Journal of the Association of University Programs in Health Administration·Aya AwadJames McNicholas
Jan 18, 2017·Computational and Mathematical Methods in Medicine·Selen Yılmaz IsıkhanCelal Reha Alpar
Oct 4, 2021·Cost Effectiveness and Resource Allocation : C/E·Yanjie HuXiaozhou He

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Clinical Decision Modeling System ( CDMS )

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