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題名:尋優適應性類神經模糊推論模式於DRGs取巧行為自動檢測之應用
書刊名:資訊管理學報
作者:駱至中林錦昌
作者(外文):Lo, Chih-chungLin, Jin-chang
出版日期:2005
卷期:12:4
頁次:頁53-74
主題關鍵詞:醫療資訊學診斷關聯群前瞻性支付系統DRGs取巧行為模擬退火演算法適應性類神經模糊推論系統Medical informaticsDiagnostic related groupsProspective payment systemDRGPPSDRGs creepsSimulated annealing algorithmAdaptive network-based fuzzy inference systemANFIS
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(4) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:4
  • 共同引用共同引用:38
  • 點閱點閱:45
中央健保局為控制國內醫療費用的成長並有效運用醫療資源,將逐步實施總額預算制度,而「診斷關聯群前瞻性支付」(簡稱DRG/PPS)是新制度中醫療費用分配與支付的基準。為求執行上的公平與正確,如何有效審查進而抑制醫療服務提供者在申請給付時有意或無意間產生的DRGs取巧行為,即成為醫療服務管理的重要課題。此類資訊密集的審查作業目前仍以人工審查為主,實有導入資訊科技的必要。本研究以整合模擬退火演算法與適應性類神經模糊推論系統的方式來建構「尋優適應性類神經模糊推論模式」,並以此智慧型機制進行DRGs取巧行為是否存在的自動檢測。實例驗證的結果顯示:本研究所提模式不僅有高於其他功能相似系統的平均分類正確率(90.10%).更在決策支援方面有較高的透明度及可信賴度。
In order to control the growing costs of healthcare spending, the Bureau of National Health Insurance is adopting the Global Budget System. In this new system, Diagnostic Related Groups/Prospective Payment System (DRG/PPS) is the mechanism for payment evaluation and control. Many healthcare frauds, also known as DRGs creeps, have been found in other countries that have already implemented the similar payment systems. For a fair and effective execution of such payment system, elimination of these frauds becomes an important task for healthcare administration. Detecting DRGs creeps manually is costly. However, costs to tailor packages to fit the detection needs and integrate them into an existing environment are outrageous. In this research, a hybrid soft computing model that integrates simulated annealing and adaptive-network-based fuzzy inference system (ANFIS) is proposed for the automated detection of DRGs creeps. The proposed approach is affordable for healthcare units at all levels. Implementation and evaluation results demonstrate that the proposed hybrid model has improved overall performance in identifying DRGs creeps.
期刊論文
1.韓揆(20010800)。互斥、非互斥?診斷組合(DRGs)分類結構之辨。臺灣公共衛生雜誌,20(4),259-264。new window  延伸查詢new window
2.賴憲堂、韓揆、張鳳智(19960600)。DRGs償付制度與醫院疾病編碼取巧行為之可能性。醫院,29(3),31-46。  延伸查詢new window
3.Bonissone, P. P.、Chen, Y. T.、Goebel, K.、Khedkar, P. S.(1999)。Hybrid soft computing systems: Industrial and commercial applications。Proceedings of the IEEE,87(9),1641-1667。  new window
4.賴憲堂、楊志良、范碧玉(19980800)。全民健康保險下疾病分類編碼品質與相關影響因素研究。中華公共衛生雜誌,17(4),337-348。new window  延伸查詢new window
5.黃興進(20020200)。醫療資訊管理系統研究議題之探討。資訊管理學報,9(專刊),101-116。new window  延伸查詢new window
6.張智星(1993)。ANFIS: Adaptive-network-based Fuzzy Inference Systems。IEEE Transactions on System, Man and Cybernetics,23(3),665-685。  new window
7.Ishibuchi, H.、Nakashima, T.(2001)。Effect of Rule Weights in Fuzzy Rule-based Classification Systems。IEEE Transactions on Fuzzy Systems,9(4),506-515。  new window
8.Sintchenko, Vitali、Coiera, Enrico W.(2003)。Which Clinical Decisions Benefit from Automation? A Task Complexity Approach。International Journal of Medical Informatics,70(2/ 3),309-316。  new window
9.Staiano, A.、Sessa, S.、Tagliaferri, R.、Loia, V.(2000)。Merging Fuzzy Logic, Neural Networks, and Genetic Computation in the Design of a Decision-support System。International Journal of Intelligent Systems,15(7),575-594。  new window
10.De Azevedo, Fernando Mendes、Brasil, Lourdes Mattos、Barreto, Jorge Muniz(2001)。Hybrid Expert System for Decision Supporting in the Medical Area: Complexity and Cognitive Computing。International Journal of Medical Informatics,63(1/ 2),19-30。  new window
11.Ovaska, Seppo J.、Dote, Yasuhito(2001)。Industrial Applications of Soft Computing: A Review。Proceedings of the IEEE,89(9),1243-1265。  new window
12.McGinnity, T. M.、Fenton, William G.、Maguire, Liam P.(2001)。Fault Diagnosis of Electronic Systems Using Intelligent Techniques: A Review。IEEE Transactions on Systems, Man, and Cybernetics, Part C: Applications and Reviews,31(3),269-281。  new window
13.Lozano, Manuel、Herrera, Francisco(2001)。Adaptive Genetic Operators Based on Coevolution with Fuzzy Behaviors。IEEE Transactions on Evolutionary Computation,5(2),149-165。  new window
14.Woo, Kwang B.、Woo, Chun-Hee、Hwang, Hee-Soo、Kang, Sin-Jun(2000)。Evolutionary Design of Fuzzy Rule Base for Nonlinear System Modeling and Control。IEEE Transactions on Fuzzy Systems,8(1),37-45。  new window
15.Kasabov, Nikola K.(1996)。Learning Fuzzy Rules and Approximate Reasoning in Fuzzy Neural Networks and Hybrid Systems。Fuzzy Sets and Systems,82(2),135-149。  new window
16.Mills, G. H.、Linkens, D. A.、Kwok, H. F.、Mahfouf, M.(2003)。Rule-base Derivation for Intensive Care Ventilator Control Using ANFIS。Artificial Intelligence in Medicine,29(3),185-201。  new window
17.Simborg, Donald W.(1981)。DRG Creep - A New Hospital-acquired Disease。The New England Journal of Medicine,304,1602-1604。  new window
18.Basak, Jayanta、Mitra, Sushmita(2001)。FRBF: A Fuzzy Radial Basis Function Network。Neural Computing & Applications,10(3),244-252。  new window
19.Mitra, Sushmita、Hayashi, Yoichi(2000)。Neuro-fuzzy Rule Generation: Survey in Soft Computing Framework。IEEE Transactions on Neural Networks,11(3),748-768。  new window
會議論文
1.戴丁榮、駱至中、王鄭慈、林錦昌(2004)。自動檢測DRG取巧行為之遺傳模糊專家系統。臺北縣新莊市。  延伸查詢new window
2.戴丁榮、駱至中、劉明華(2001)。DRG取巧行為之智慧型與自動化檢測。雲林縣斗六市。  延伸查詢new window
圖書
1.莊逸洲、黃崇哲(2000)。醫療機構管理制度。台北:華杏。  延伸查詢new window
2.Jordan, Theresa J.(2002)。Understanding Medical Information: A User's Guide to Informatics and Decision Making。Understanding Medical Information: A User's Guide to Informatics and Decision Making。New York, NY。  new window
其他
1.林雨靜(2001)。全民健保支付制度的改革-總額預算,0。  延伸查詢new window
 
 
 
 
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