Reducing low value services in surgical inpatients in Taiwan: Does diagnosis-related group payment work?

Associations of Chinese diagnosis-related group system with low-value coronary revascularisation: an interrupted time series analysis

OBJECTIVES

This study aimed to investigate whether the Chinese diagnosis-related group (C-DRG) payment system would reduce low-value coronary revascularisation services among coronary heart disease (CHD) inpatients without affecting high-value coronary revascularisation services.

DESIGN

Retrospective observational study.

SETTING

Routinely collected claims data from a health insurance database including all inpatients in 22 public hospitals in Sanming, Southern China.

PARTICIPANTS

All patients with CHD are admitted to public hospitals from 1 January 2017 through 31 December 2020.

INTERVENTION/EXPOSURE

The implementation of the C-DRG-based payment system on 1 January 2018.

MAIN OUTCOME MEASURES

Using a health insurance database, we identified two cohorts: beneficiaries for whom the value of coronary revascularisation is lower (those with ischaemic heart disease without acute myocardial infarction, unstable angina and congestive heart failure during hospitalisation) and beneficiaries for whom its value is higher (those with acute coronary syndrome). Then, the rates of low-value or high-value coronary revascularisation were compared before and after the implementation of C-DRG policy, including the use of an interrupted time series analysis.

RESULTS

An interrupted time series analysis demonstrated that the C-DRG policy was associated with a statistically significant immediate decrease in the rate of low-value coronary revascularisation of -9.78% (95% CI: -11.08% to -8.48%). Further, after introducing C-DRG, the rate of low-value coronary revascularisation decreased by -0.59% (95% CI: -0.88% to -0.30%) every quarter compared with before C-DRG. In addition, after C-DRG, the rate of high-value coronary revascularisation increased by 1.27% (95% CI: 0.14% to 2.41%) every quarter compared with before C-DRG.

CONCLUSIONS

This study suggested that C-DRG policy achieved at least short-term success in reducing use of low-value coronary revascularisation without evidence of decreasing high-value coronary revascularisation services. These results can support policymakers in reducing low-value care in China and other countries that use similar systems.

Multicomponent processes to identify and prioritise low-value care in hospital settings: a scoping review

OBJECTIVES

This scoping review mapped and synthesised original research that identified low-value care in hospital settings as part of multicomponent processes.

DESIGN

Scoping review.

DATA SOURCES

Electronic databases (EMBASE, PubMed, CINAHL, PsycINFO and Cochrane CENTRAL) and grey literature were last searched 11 July and 3 June 2022, respectively, with no language or date restrictions.

ELIGIBILITY CRITERIA

We included original research targeting the identification and prioritisation of low-value care as part of a multicomponent process in hospital settings.

DATA EXTRACTION AND SYNTHESIS

Screening was conducted in duplicate. Data were extracted by one of six authors and checked by another author. A framework synthesis was conducted using seven areas of focus for the review and an overuse framework.

RESULTS

Twenty-seven records were included (21 original studies, 4 abstracts and 2 reviews), originating from high-income countries. Benefit or value (11 records), risk or harm (10 records) were common concepts referred to in records that explicitly defined low-value care (25 records). Evidence of contextualisation including barriers and enablers of low-value care identification processes were identified (25 records). Common components of these processes included initial consensus, consultation, ranking exercise or list development (16 records), and reviews of evidence (16 records). Two records involved engagement of patients and three evaluated the outcomes of multicomponent processes. Five records referenced a theory, model or framework.

CONCLUSIONS

Gaps identified included applying systematic efforts to contextualise the identification of low-value care, involving people with lived experience of hospital care and initiatives in resource poor contexts. Insights were obtained regarding the theories, models and frameworks used to guide initiatives and ways in which the concept 'low-value care' had been used and reported. A priority for further research is evaluating the effect of initiatives that identify low-value care using contextualisation as part of multicomponent processes.

A taxonomy of Chinese hospitals and application to medical dispute resolutions

Medical disputes can be viewed as a negative indicator of health care quality and patient satisfaction. However, dispute prevention from the perspective of systematic supervision is unexplored. This study examines hospital clustering based on diagnosis-related group (DRG) indicators and explores the association between hospital clusters and medical disputes. Health administrative data from Sichuan Province in 2017 were used. A twostep cluster analysis was performed to cluster hospitals based on DRG indicators. A multiple regression analysis was conducted to evaluate the relationship between clusters and the incidence/number of medical disputes. The 1660 hospitals were grouped into three DRG clusters: basic (62.5%, n = 1038), diverse (31.0%, n = 515), and lengthy (6.4%, n = 107). After adjusting for covariates, the diverse hospitals were associated with an increased probability of having medical disputes (OR 5.24, 95% CI 2.97-9.26), while the diverse and lengthy hospitals were associated with a greater number of medical disputes (IRR 10.67, 95% CI 6.58-17.32; IRR 4.06, 95% CI 1.22-13.54). Our findings highlighted that the cluster-level performance of hospitals can be monitored. Future studies could examine this relationship using a longitudinal design and explore ways to reduce medical disputes in hospitals.

The development of one-day surgical care in Hungary between 2010 and 2019

BACKGROUND

The constant increase in the utilization of one-day surgical care could be identified since more than a decade in most of European countries. Initially, according to the international rankings, the exploitation of one-day surgery in Hungary was not really significant. In 2010, the Hungarian policy makers intended to increase one-day surgical care as a priority strategy. The aim of our study was to analyze the evolution of the Hungarian one-day surgical care during the last decade in DRG- based performance financing system in Hungary.

METHODS

The dataset of the research was provided by the National Health Insurance Fund Administration of Hungary. The most important indicators related to the one-day surgical care were compared to inpatient care (market share, number of cases, and DRG cost-weights). To discover the impact of one-day surgical care to the utilization of inpatient treatment, the number of hospitalized days was also analyzed.

RESULTS

Between 2010 and 2019, the market share of one-day surgical cases increased from 42, to 80%. Simultaneously the constant increase of one-day surgical cases, the number of hospitalized days were decreased in inpatient care by 17%. The value of Case Mix Index has also increased, approximately by 140%, which could confirm that more complex interventions are being conducted in one-day surgical care as well.

CONCLUSIONS

Due to the comprehensive health policy strategy related to the dissemination of one-day surgical care in Hungary, several important performance indicators were improved between 2010 and 2019. Given that Hungary belongs to the low- and middle-income countries, the results of the study could be considerable even in an international comparison.

Prediction of Obstetric Patient Flow and Horizontal Allocation of Medical Resources Based on Time Series Analysis

Objective: Given the ever-changing flow of obstetric patients in the hospital, how the government and hospital management plan and allocate medical resources has become an important problem that needs to be urgently solved. In this study a prediction method for calculating the monthly and daily flow of patients based on time series is proposed to provide decision support for government and hospital management.

Methods: The historical patient flow data from the Department of Obstetrics and Gynecology of the First Hospital of Jilin University, China, from January 1, 2018, to February 29, 2020, were used as the training set. Seven models such as XGBoost, SVM, RF, and NNAR were used to predict the daily patient flow in the next 14 days. The HoltWinters model is then used to predict the monthly flow of patients over the next year.

Results: The results of this analysis and prediction model showed that the obstetric inpatient flow was not a purely random process, and that patient flow was not only accompanied by the random patient flow but also showed a trend change and seasonal change rule. ACF,PACF,Ljung_box, and residual histogram were then used to verify the accuracy of the prediction model, and the results show that the Holtwiners model was optimal. R2, MAPE, and other indicators were used to measure the accuracy of the 14 day prediction model, and the results showed that HoltWinters and STL prediction models achieved high accuracy.

Conclusion: In this paper, the time series model was used to analyze the trend and seasonal changes of obstetric patient flow and predict the patient flow in the next 14 days and 12 months. On this basis, combined with the trend and seasonal changes of obstetric patient flow, a more reasonable and fair horizontal allocation scheme of medical resources is proposed, combined with the prediction of patient flow.

Augmentation in Healthcare Utilization of Patients with Opioid Use Disorder After Methadone Maintenance Treatment: A Retrospective Nationwide Study

INTRODUCTION

The health benefits of entering methadone maintenance treatment (MMT) for opioid-dependent persons may not be merely limited to therapy of opioid use disorder. We aimed to compare the healthcare utilization of MMT patients before and after MMT.

METHODS

A retrospective analysis was performed using the Taiwan Illicit Drug Issue Database and the National Health Insurance Research Database (NHIRD) between 2014 and 2016. We included 1255 newly enrolled MMT patients in 2015 and randomly selected 5020 patients from NHIRD matched by age and gender as the comparison group. Changes in healthcare utilization 1 year before and 1 year after the date of the index date (MMT initiation) were compared within and between MMT and comparison groups.

RESULTS

During the 1-year period following MMT, the hospitalization length was considerably decreased, while the number of outpatient visits, emergency department (ED) visits, and ED expenditure significantly increased in MMT patients. Multivariable linear regression with the difference-in-difference approach revealed that all the categories of healthcare utilization increased, except for a minor increase of outpatient expenditure and a slight decrease of hospitalization length for the MMT group relative to the comparison group. Increases in utilization of the departments of psychiatry and infectious diseases of the MMT patients were considerable.

CONCLUSION

MMT is associated with increased healthcare utilization, and departments of psychiatry and infectious diseases play substantial roles. Policy-makers should warrant access for all who need healthcare by ensuring the availability of the treatment for drug dependence.