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1、UsingKnowledgeDiscoverytoDevelopmentaProcedureforDRGsByWen-HsiangWuDepartmentofHealthcareManagement,YuanpeiUniversityofScienceandTechnology,Hsinchu,TaiwanE-mail:wenhsiang_wu@yahoo.com.twShuenn-RenChengDepartmentofBusinessChengShiuUniversityKaohsiung,TaiwanE-mail:tommy@csu.edu.twJuei-ChaoChenG
2、radateInstituteofAppliedStatistics,FuJenCatholicUniversity,Taipei,TaiwanE-mail:statl()14@mail.fju.edu.twDonJyh-FuJengGraduateSchoolofInformation,ProductionandSystemsWasedaUniversityKitakyushu,JapanE-mail:don_jeng@yahoo.comMei-RoungChenGradateInstituteofAppliedStatistics,FuJenCatholicUniversit
3、y,Taipei,TaiwanE-mail:may()611@mail2000.com.twAbstractThepurposeofthisstudyistodevelopadiagnostic-relatedgroups(DRGs)systemwithbetterforecastingabilityinmedicalexpensesthroughtheknowledgediscoveryprocessandclassificationandregressiontree(C&RT)indatamining.UnitedStatesusestheCentersforMedicare
4、andMedicaidDRGs(CMS-DRGs)asareimbursementbasisformedicalexpenses,butthemostcontroversialisitsinsufficientabilityinmedicalexpensesforecasting.Inthisresearch,thediseasecategoryofICD-9CMisusedinreplacingthemajorandsecondarydianositiccategoryofCMS-DRGs,andbyaddingthestageofdiseasetosolvetheinsuff
5、icientabilityinmedicalexpensesforecastingthatcausesbytheCMS-DRGsonlytakethecomplicationsandcomorbiditiesintoconsideration.Furthermore,withtheclassificationofproceduresofICD-9CM,thecaseswithsimilarmedicalexpensisaremixedforimprovingtheDRGs5forecastingability.Thehealthcareadministratorcanbenefi
6、tformthisresearchbymodifyingtheDRGssystemtoavoidtheopportunisticbehaviorfrommedicalproviders-Ontheotherhand,themedicalproviderscanbenefitfromthisresearchbyunderstandthecostofdifferentdiseasecategoryanddifferentoperation,andfurtherevaluatethecostwithitsbudget.Thepatientsofgastriccanceraretaken
7、asanexampleinthisstudy.Keywords:case-mix,classificationandregressiontree(C&RT),datamining,gastriccancer,knowledgediscoveryprocess.1.IntroductionThediagnosis-relatedgroups(DRGs)wascreatedbyYaleUniversityinthe1960s,whichismainlyusedformeasuring
