Impact of Diagnosis-Related Groups on Inpatient Quality of Health Care: A Systematic Review and Meta-Analysis

Economic burden of hospitalization for Chinese children with chronic kidney disease: a comparison between patients with and without infection

Objective

To assess hospitalization costs in pediatric chronic kidney disease (CKD) patients, compare the economic burden between those with and without infections, and identify key factors influencing these costs, emphasizing the significant financial impact on families and healthcare systems.

Methods

This retrospective analysis included pediatric patients with CKD hospitalized between May 2011 and April 2020. Clinical characteristics, including demographics, etiology, urinary protein level, estimated glomerular filtration rate, and CKD stage, were analyzed. Hospitalization costs were compared between groups with and without infection using appropriate statistical methods.

Results

Among 721 pediatric CKD patients included in this study, 388 had primary kidney disease and 333 had secondary kidney disease. Patients in the infection group had significantly higher urine protein levels, longer hospital stays, and higher total hospital fees than those without infection (all P < 0.05). In the primary kidney disease cohort, patients aged 14-18 years incurred the highest costs (16,706 CNY, P = 0.009), while those with 1 + urine protein levels had expenses averaging 29,813 CNY (P = 0.035). In the secondary kidney disease cohort, the 3 + urine protein group had the highest costs (62,841 CNY, P < 0.001). Multiple linear regression identified age, urine protein level, and length of hospital stay as significant cost determinants. Patients with infection in the secondary kidney disease cohort had an average additional expenditure of 13,572.55 CNY compared to those without infection (P = 0.001).

Conclusion

This study highlights the economic burden of infection during pediatric CKD hospitalization, emphasizing the need for effective infection management strategies to reduce financial strain and improve outcomes.

Antimicrobial Drug Use and Changing Trends From 2021 to 2023-A Case Study of a General Hospital in Sichuan Province

BACKGROUND

Antibiotic resistance (AR) is a growing concern as a result of the widespread and excessive use of antibiotics. Because of this, China's health authorities have implemented a number of antibiotic control measures, including a requirement that the intensity of antibiotic usage stay within 40.00 DDDs. This study, which used a tertiary general hospital in Sichuan Province as an example, examined the hospital's trend in antibiotic use from 2021 to 2023, the relationship between antibiotic use and hospitalization days and CMI, and the viability of 40.000 DDDs in light of the evolving medical landscape.

METHODS

Data were obtained through the hospital information system (HIS) and the hospital DRG system. Boston matrix diagrams were used to find the departments that needed to be focused on control, Cochran-Armitage trend test, and ANOVA to analyze the trends of AUR and antimicrobial use density (AUD) in the hospital over time in the last 3 years and to analyze the factors affecting the changes in antibiotic consumption.

RESULTS

Over the previous 3 years, the hospital's antibiotic use rate varied between 40% and 50%, and its intensity of use varied between 40.000 and 50.000 DDDs, both of which were rather steady. January 2023 had a significant rise, with an AUD of 59.38 DDDs and an AUR of 61.80%. The second quadrant has eight departments. Each department's AUD varied dramatically; neurosurgery saw an increase annually (p < 0.05), abdominal wall surgery and gastrointestinal hernia procedures, obstetrics and gynaecologist, and ophthalmology saw a drop annually (p < 0.05). The average number of preoperative hospitalization days (r = 0.1402, p < 0.01) and the CMI (r = 0.4864, p < 0.001) were strongly connected with the AUD of surgical and nonsurgical departments, respectively.

CONCLUSIONS

Hospitals should concentrate on the issue of surgical departments' lengthy preoperative prophylactic medication times. AUD management should also be dynamically modified based on CMI, particularly in departments in the second quadrant (low CMI and high AUD). Furthermore, it is challenging to maintain the hospital AUD target value of 40.00 DDDs under the new medical model, given the decline in hospitalization days of discharged patients and the high prevalence of infectious diseases. It is also unclear whether this target value is still appropriate given the current state of medicine.

Impact of a new case-based payment scheme on volume distribution across public hospitals in Zhejiang, China: does 'Same disease, same price' matter

BACKGROUND

With the implementation of the hierarchical medical system (HMS) in China, Zhejiang Province introduced an innovative payment scheme called "payment method by disease types with point counting". This scheme was initially adopted in Jinhua in July 2017, and was later integrated with the "same disease, same price" policy in Hangzhou in January 2020. This study aimed to investigate the impact of these reforms on the distribution of health service volume.

METHODS

Data were obtained from 104 hospitals, including 12 tertiary and 14 secondary hospitals from each of four regions: Jinhua (intervention) vs. Taizhou (control), and Hangzhou (intervention) vs. Ningbo (control). A total of 3848 observation points were examined using two sets of controlled interrupted time series analyses to assess the effects of this new case-based payment, without and with "same disease, same price", on the proportion of discharges, total medical revenue and hospitalization revenue. The Herfindahl-Hirschman Index (HHI) were analyzed to evaluate changes in market competition.

RESULTS

Following the introduction of the new case-based payment without "same disease, same price", secondary hospitals in Jinhua experienced a significant decline in the proportion of discharges (β6 = -0.1074, p = 0.047), total medical revenue (β6 = -0.0729, p = 0.026), and hospitalization revenue (β6 = -0.1062, p = 0.037) compared to those in Taizhou, while tertiary hospitals showed a non-significant increase. After incorporating "same disease, same price", the proportion of discharges (β6 = 0.2015, p = 0.031), total medical revenue (β6 = 0.1101, p = 0.041) and hospitalization revenue (β6 = 0.1248, p = 0.032) in Hangzhou's secondary hospitals increased compared with Ningbo's, yet the differences in both the level and trend changes between tertiary hospitals in the two cities were not statistically significant. The HHI in Jinhua (β7 = 0.0011, p = 0.043) presented an upward trend during the pilot period of the case-based payment, while the HHI in Hangzhou (β6 = -0.0234, p = 0.021) decreased immediately after the introduction of "same disease, same price".

CONCLUSION

This new case-based payment scheme may worsen the disproportionate distribution of service volume across hospitals of different levels. While "same disease, same price" shows potential benefits, further evidence is needed to assess its effectiveness in promoting HMS. Policymakers should consider hospital interests in payment design and address unintended strategic behaviors.

[New management models or traditional hospital management? Transition of a hospital-foundation in a Euroregion]

BACKGROUND

This study aims to assess the impact of transitioning a hospital/foundation from indirect management to direct management on the efficiency of hospital resource management.

METHODOLOGY

Until 2010, the Virxe da Xunqueira hospital/foundation, located in the Galicia-North Portugal Euroregion, operated under indirect management. In 2010, it transitioned to direct management as a health centre within the Galician Health Service (Spain). Public management of hospital resources was compared using data development analysis for two periods: indirect management (2005-2009) and direct management (2011-2015). Inputs included labour (number of workers) and capital (number of beds), while outputs were measured by the number of consultations, emergencies, interventions, admissions (inpatients), hospital stays, patients on waiting the list, average length of stay, waiting times, and hospital occupancy rate. The synthetic index used was the basic care units.

RESULTS

Virxe da Xunqueira demonstrated greater efficiency as a hospital/foundation in terms of the number of consultations, emergencies, admissions, inpatients, and indicators related to patient stay (including number and average length of stay). After transitioning to direct management, the hospital showed improved efficiency in average waiting times, the number of patients on the waiting list, and the number of surgical interventions. The production factors exhibited decreasing returns to scale in both types of governance.

CONCLUSIONS

Both type of management show greater efficiency in certain inputs. However, there is insufficient evidence to conclude that the previous management model (indirect management) is more efficient than direct management.

The Impact of DRG-Based Payment Reform on the Efficiency of Medical Care for Patients with Myocardial Infarction: Evidence from Georgia

In Georgia, a prospective financing system for hospital services using diagnosis-related groups (DRGs) was introduced in 2022 to increase the efficiency and transparency of the healthcare system. The purpose of this study is to evaluate the impact of DRG-based hospital reimbursement on the efficiency of medical care for patients with myocardial infarction. Hospitalization data from three large hospitals in Georgia before and after the introduction of DRGs, covering the period from 2021 to 2024, were analyzed. The study found that the implementation of DRGs in cardiology hospitals reduced length of stay, readmission, and mortality rates. Although the prices for nosologies have increased, patients' direct out-of-pocket payments have decreased, thereby improving financial access to medical services. The introduction of the DRG payment system had a positive effect on patient financial accessibility.

Evaluation of the impact of prospective payment systems on cholecystectomy: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the impact of prospective payment systems (PPSs) on cholecystectomy. A comprehensive literature review was conducted, examining studies published until December 2023. The review process focused on identifying research across major databases that reported critical outcomes such as length of stay (LOS), mortality, complications, admissions, readmissions, and costs following PPS for cholecystectomy. The studies were specifically selected for their relevance to the impact of PPS or the transition from fee-for-service (FFS) to PPS. The study analyzed six papers, with three eligible for meta-analysis, to assess the impact of the shift from FFS to PPS in laparoscopic and open cholecystectomy procedures. Our findings indicated no significant changes in LOS and mortality rates following the transition from FFS to PPS. Complication rates varied and were influenced by the diagnosis-related group categorization and surgeon cost profiles under episode-based payment. There was a slight increase in admissions and readmissions, and mixed effects on hospital costs and financial margins, suggesting varied responses to PPS for cholecystectomy procedures. The impact of PPS on cholecystectomy is nuanced and varies across different aspects of healthcare delivery. Our findings indicate a need for adaptable, patient-centered PPS models that balance economic efficiency with high-quality patient care. The study emphasizes the importance of considering specific surgical procedures and patient demographics in healthcare payment reforms.

Exploring hot topics and evolutionary paths in the Diagnosis-Related Groups (DRGs) field: a comparative study using LDA modeling

BACKGROUND

This study reviews the research status of Diagnosis-related groups (DRGs) payment system in China and globally by analyzing topical issues in this field and exploring the evolutionary trends of DRGs in different developmental stages.

METHODS

Abstracts of relevant literature in the field of DRGs were extracted from the China National Knowledge Infrastructure (CNKI) database and the Web of Science (WoS) core database and used as text data. A probabilistic distribution-based Latent Dirichlet Allocation (LDA) topic model was applied to mine the text topics. Topical issues were determined by topic intensity, and the cosine similarity of the topics in adjacent stages was calculated to analyze the topic evolution trend.

RESULTS

A total of 6,758 English articles and 3,321 Chinese articles were included. Foreign research on DRGs focuses on grouping optimization, implementation effects, and influencing factors, whereas research topics in China focus on grouping and payment mechanism establishment, medical cost change evaluation, medical quality control, and performance management reform exploration.

CONCLUSIONS

Currently, the field of DRGs in China is developing rapidly and attracting deepening research. However, the implementation depth of research in China remains insufficient compared with the in-depth research conducted abroad.

The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis

PURPOSE

The aim of this study was to assess how physicians perceive the role of the reimbursement system and its potential influence in affecting their treatment choice in the management of patients affected by osteoarthritis (OA).

METHODS

A survey was administered to 283 members of SIAGASCOT (Italian Society of Arthroscopy, Knee, Upper Limb, Sport, Cartilage and Orthopaedic Technologies), a National scientific orthopaedic society. The survey presented multiple choice questions on the access allowed by the current Diagnosis-Related Groups (DRG) system to all necessary options to treat patients affected by OA and on the influence toward prosthetic solutions versus other less invasive options.

RESULTS

Almost 70% of the participants consider that the current DRG system does not allow access to all necessary options to best treat patients affected by OA. More than half of the participants thought that the current DRG system favors the choice of prosthetic solutions (55%) and that it can contribute to the increase in prosthetic implantation at the expense of less invasive solutions (54%). The sub-analyses based on different age groups, professional roles, and places of work allowed to evaluate the response in each specific category, confirming the findings for all investigated aspects.

CONCLUSIONS

This survey documented that the majority of physicians consider that the reimbursement system can influence the treatment choice when managing OA patients. The current DRG system was perceived as unbalanced in favor of the choice of the prosthetic solution, which could contribute to the increase in prosthetic implantation at the expense of other less invasive options for OA management.

Construction and application of a nursing human resource allocation model based on the case mix index

BACKGROUND

The case mix index (CMI) may reflect the severity of disease and the difficulty of care objectively, and is expected to be an ideal indicator for assessing the nursing workload. The purpose of this study was to explore the quantitative relationship between daily nursing worktime (DNW) and CMI to provide a method for the rational allocation of nursing human resources.

METHODS

Two hundred and seventy-one inpatients and 36 nurses of the department of hepatobiliary surgery were prospectively included consecutively from August to September 2022. The DNW of each patient were accurately measured, and the CMI data of each patient were extracted. Among 10 curve estimations, the optimal quantitative model was selected for constructing the nursing human resource allocation model. Finally, the applicability of the allocation model was preliminarily assessed by analyzing the relationship between the relative gap in nursing human resources and patient satisfaction, as well as the incidence of adverse events in 17 clinical departments.

RESULTS

The median (P25, P75) CMI of the 271 inpatients was 2.62 (0.92, 4.07), which varied by disease type (F = 3028.456, P < 0.001), but not by patient gender (F = 0.481, P = 0.488), age (F = 2.922, P = 0.089), or level of care (F = 0.096, P = 0.757). The median (P25, P75) direct and indirect DNW were 76.07 (57.98, 98.85) min and 43.42 (39.42, 46.72) min, respectively. Among the 10 bivariate models, the quadratic model established the optimal quantitative relationship between CMI and DNW; DNW = 92.3 + 4.8*CMI + 2.4*CMI2 (R2 = 0.627, F = 225.1, p < 0.001). The relative gap between theoretical and actual nurse staffing in the 17 clinical departments were linearly associated with both patient satisfaction (r = 0.653, P = 0.006) and incidence of adverse events (r = - 0.567, P = 0.021). However, after adjusting for other factors, it was partially correlated only with patient satisfaction (rpartial = 0.636, P = 0.026).

CONCLUSION

The DNW derived from CMI can be used to allocate nursing human resources in a rational and convenient way, improving patient satisfaction while ensuring quality and safety.