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Tian W, Zhang S, Gao Y, Wang Y, Cui Q. Drug utilization reviews to reduce inappropriate drug use and pharmaceutical costs in inpatients based on diagnosis-related group data. Technol Health Care 2024:THC240284. [PMID: 39031409 DOI: 10.3233/thc-240284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
BACKGROUND Irrational pharmacotherapy and increasing pharmacy costs remain major concerns in healthcare systems. Pharmacists are expected to employ diagnosis-related group (DRG) data to analyse inpatient pharmacy utilization. OBJECTIVE This project aimed to pilot an efficient pharmacist-led programme to analyse factors related to pharmacy expenses, evaluate the rational use of drugs in batch processing, and make further interventions based on DRG data. METHODS Patients from the OB25 (caesarean section without comorbidities or complications) DRG were selected in 2018, and the most relevant factors were identified through statistical analysis. Interventions were implemented by sending monthly reports on prescribing data and drug review results for the same DRGs to the department starting in 2019. Pre-post comparisons were conducted to demonstrate changes in pharmacy costs and appropriateness at a tertiary teaching hospital with 2,300 beds in China. RESULTS A total of 1,110 patients were identified from the OB25 DRG data in 2018. Multivariate linear analysis indicated that the number of items prescribed and wards substantially influenced pharmacy expenditure. Drugs labelled as vital, essential, and non-essential revealed that 46.6% of total pharmacy costs were spent on non-essential drugs, whereas 38.7% were spent on vital drugs. The use of inappropriate pharmaceuticals and drug items was substantially reduced, and the average pharmacy cost after intervention was 336.7 RMB in 2020. The benefit-cost ratio of the programme was 9.86. CONCLUSION Interventions based on DRG data are highly efficient and feasible for reducing inpatient pharmacy costs and non-essential drug use.
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Affiliation(s)
- Wei Tian
- Department of Pharmacy, The First College of Clinical Medicine Science, Three Gorges University, Yichang, China
- Department of Pharmacy, Yichang Central People's Hospital, Yichang, China
| | - Sheng Zhang
- Department of Pharmacy, The First College of Clinical Medicine Science, Three Gorges University, Yichang, China
- Department of Pharmacy, Yichang Central People's Hospital, Yichang, China
| | - Yuan Gao
- Department of Pharmacy, The First College of Clinical Medicine Science, Three Gorges University, Yichang, China
- Department of Pharmacy, Yichang Central People's Hospital, Yichang, China
| | - Yan Wang
- Department of Pharmacy, The First College of Clinical Medicine Science, Three Gorges University, Yichang, China
- Department of Pharmacy, Yichang Central People's Hospital, Yichang, China
| | - Qianqian Cui
- Department of Pharmacy, The First College of Clinical Medicine Science, Three Gorges University, Yichang, China
- Department of Pharmacy, Yichang Central People's Hospital, Yichang, China
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Liu Y, Du S, Cao J, Niu H, Jiang F, Gong L. Effects of a Diagnosis-Related Group Payment Reform on Length and Costs of Hospitalization in Sichuan, China: A Synthetic Control Study. Risk Manag Healthc Policy 2024; 17:1623-1637. [PMID: 38904006 PMCID: PMC11189311 DOI: 10.2147/rmhp.s463276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024] Open
Abstract
Background Diagnosis-related group (DRG) payment policies are increasingly recognized as crucial instruments for addressing health care overprovision and escalating health care costs. The synthetic control method (SCM) has emerged as a robust tool for evaluating the efficacy of health policies worldwide. Methods This study focused on Panzhihua city in Sichuan Province, a pilot city for DRG payment reform implementation, serving as the treatment group. In contrast, 20 nonpilot cities within the province were utilized as potential control units. A counterfactual control group was constructed to evaluate the changes in average inpatient stay duration and health care organization costs following the DRG payment reform initiated in 2018. Results Focusing on Panzhihua, Sichuan Province, the analysis reveals that following the reform in March 2018, the average length of hospital stay in Panzhihua decreased by 1.35 days during 2019-2021. Additionally, the average cost per hospitalization dropped by 855.48 RMB, the average cost of medication per hospitalization decreased by 68.51 RMB, and the average cost of diagnostic and therapeutic procedures per hospitalization declined by 136.37 RMB. While global evidence backs DRGs for efficiency and cost reduction, challenges persist in addressing emerging issues like new conditions. Conclusion Since its introduction in 2018, the DRG payment reform in Sichuan Province has effectively reduced both the duration of hospital stays and the operational costs of health care facilities. However, potential drawbacks include compromised service quality and an elevated risk of patient readmission, indicating a need for further refinement in the implementation of DRG payment reforms in China.
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Affiliation(s)
- Yaqing Liu
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Huazhong University of Science and Technology’s Double First-Class Discipline Platform in Humanities (Research Center for Hospital High-Quality Development), Wuhan, Hubei, People’s Republic of China
| | - Sixian Du
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Jianbo Cao
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Haoran Niu
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Feng Jiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Liwen Gong
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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Ren S, Yang L, Du J, He M, Shen B. DRGKB: a knowledgebase of worldwide diagnosis-related groups' practices for comparison, evaluation and knowledge-guided application. Database (Oxford) 2024; 2024:baae046. [PMID: 38843311 PMCID: PMC11155695 DOI: 10.1093/database/baae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/08/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
As a prospective payment method, diagnosis-related groups (DRGs)'s implementation has varying effects on different regions and adopt different case classification systems. Our goal is to build a structured public online knowledgebase describing the worldwide practice of DRGs, which includes systematic indicators for DRGs' performance assessment. Therefore, we manually collected the qualified literature from PUBMED and constructed DRGKB website. We divided the evaluation indicators into four categories, including (i) medical service quality; (ii) medical service efficiency; (iii) profitability and sustainability; (iv) case grouping ability. Then we carried out descriptive analysis and comprehensive scoring on outcome measurements performance, improvement strategy and specialty performance. At last, the DRGKB finally contains 297 entries. It was found that DRGs generally have a considerable impact on hospital operations, including average length of stay, medical quality and use of medical resources. At the same time, the current DRGs also have many deficiencies, including insufficient reimbursement rates and the ability to classify complex cases. We analyzed these underperforming parts by domain. In conclusion, this research innovatively constructed a knowledgebase to quantify the practice effects of DRGs, analyzed and visualized the development trends and area performance from a comprehensive perspective. This study provides a data-driven research paradigm for following DRGs-related work along with a proposed DRGs evolution model. Availability and implementation: DRGKB is freely available at http://www.sysbio.org.cn/drgkb/. Database URL: http://www.sysbio.org.cn/drgkb/.
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Affiliation(s)
- Shumin Ren
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
- Department of Computer Science and Information Technology, University of A Coruña, Faculty of Infomation, Campus of Elvina, A Coruña 15071, Spain
| | - Lin Yang
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
| | - Jiale Du
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
| | - Mengqiao He
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
| | - Bairong Shen
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
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Wang Q, Dai R, Yu Q, Zhang T, Wu B. Development of an assessment tool for designated medical institutions in China--Based on the application of an online assessment system. Front Public Health 2024; 12:1372821. [PMID: 38770361 PMCID: PMC11102995 DOI: 10.3389/fpubh.2024.1372821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
Background Due to the expanding coverage of medical insurance and the growth of medical expenses, the ability to assess the performance of designated medical institutions (DMIs) in supporting the delivery of high-quality patient care and the standardized use of funds represents a priority in China. Despite such interest, there has yet to be an operable standard and labor-saving method for assessing DMIs in China. Objective The main objectives include two aspects: (1) establishing an evaluation index system for DMIs based on contracts; (2) designing and developing an online evaluation platform. Methods A group of 20 experts with theoretical and practical expertise in medical insurance regulation and performance evaluation were invited to select available indicators. A combination weighting method based on analytic hierarchy process and entropy method was used to determine the weight coefficient. Shanghai was taken as the sample area, and 760 DMIs were included in the empirical research. The test-retest reliability method and criterion-related validity method was used to test the reliability and the validity of the evaluation result. Results An assessment index system that included 6 domains and 56 indicators was established in this study. Furthermore, we developed an online platform to assist in the implementation of the assessment. The results showed that the average score of assessment was 94.39, the median was 96.92. The test-retest reliability value was 0.96 (P ≤ 0.01), which indicated high stability of the assessment. In addition, there was a significant negative relationship between assessment score and the penalty amount of DMIs (R = -0.133, P < 0.001). After adjusting for the basic characteristics of medical institutions, the number of visits and revenue, the negative relationship was still significant (B = -0.080, P < 0.05). These results are consistent with expectations, indicating that the assessment had good criterion-related validity. Conclusions This study established an operable assessment measure and developed an online platform to assess the performance of DMIs. The results showed good feasibility and reliability in empirical research. Our research findings provided an operable Chinese solution for DMI assessment that saves manpower and time, which would have good enlightening significance in other regions of China and in low-income and middle-income countries internationally.
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Affiliation(s)
- Qian Wang
- Fudan Institute on Ageing, Fudan University, Shanghai, China
- Center for Population and Development Policy Studies, Fudan University, Shanghai, China
| | - Ruiming Dai
- School of Public Health, Fudan University, Shanghai, China
| | - Qianqian Yu
- School of Public Health, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Tiantian Zhang
- School of Public Health, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Bin Wu
- Shanghai Haiyul Information Technology Co. Ltd, Shanghai, China
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Liu Y, Wang G, Qin TG, Kobayashi S, Karako T, Song P. Comparison of diagnosis-related groups (DRG)-based hospital payment system design and implementation strategies in different countries: The case of ischemic stroke. Biosci Trends 2024; 18:1-10. [PMID: 38403739 DOI: 10.5582/bst.2023.01027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Diagnosis-related groups (DRG) based hospital payment systems are gradually becoming the main mechanism for reimbursement of acute inpatient care. We reviewed the existing literature to ascertain the global use of DRG-based hospital payment systems, compared the similarities and differences of original DRG versions in ten countries, and used ischemic stroke as an example to ascertain the design and implementation strategies for various DRG systems. The current challenges with and direction for the development of DRG-based hospital payment systems are also analyzed. We found that the DRG systems vary greatly in countries in terms of their purpose, grouping, coding, and payment mechanisms although based on the same classification concept and that they have tended to develop differently in countries with different income classifications. In high-income countries, DRG-based hospital payment systems have gradually begun to weaken as a mainstream payment method, while in middle-income countries DRG-based hospital payment systems have attracted increasing attention and increased use. The example of ischemic stroke provides suggestions for mutual promotion of DRG-based hospital payment systems and disease management. How to determine the level of DRG payment incentives and improve system flexibility, balance payment goals and disease management goals, and integrate development with other payment methods are areas for future research on DRG-based hospital payment systems.
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Affiliation(s)
- Yuan Liu
- Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gang Wang
- Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian-Ge Qin
- Anqing Medical College, Anqing, Anhui, China
| | - Susumu Kobayashi
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takashi Karako
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- National College of Nursing, Japan, Tokyo, Japan
| | - Peipei Song
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- National College of Nursing, Japan, Tokyo, Japan
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Tang X, Zhang X, Chen Y, Yan J, Qian M, Ying X. Variations in the impact of the new case-based payment reform on medical costs, length of stay, and quality across different hospitals in China: an interrupted time series analysis. BMC Health Serv Res 2023; 23:568. [PMID: 37264450 DOI: 10.1186/s12913-023-09553-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND In 2018, an innovative case-based payment scheme called Diagnosis-Intervention Packet (DIP) was piloted in a large developed city in southern China. This study aimed to investigate the impact of the new payment method on total medical expenditure per case, length of stay (LOS), and in-hospital mortality rate across different hospitals. METHODS We used the de-identified patient-level discharge data of hospitalized patients from 2016 to 2019 in our study city. The interrupted time series model was used to examine the impact of the DIP payment reform on inflation-adjusted total expenditure per case, LOS, and in-hospital mortality rate across different hospitals, which were stratified into different hospital ownerships (public and private) and hospital levels (tertiary, secondary, and primary). RESULTS We included 2.08 million and 2.98 million discharge cases of insured patients before and after the DIP payment reform, respectively. The DIP payment reform resulted in a significant increase of the monthly trend of adjusted total expenditure per case in public (1.1%, P = 0.000), tertiary (0.6%, P = 0.000), secondary (0.4%, P = 0.047) and primary hospitals (0.9%, P = 0.039). The monthly trend of LOS increased significantly in public (0.022 days, P = 0.041) and primary (0.235 days, P = 0.032) hospitals. The monthly trend of in-hospital mortality rate decreased significantly in private (0.083 percentage points, P = 0.002) and secondary (0.037 percentage points, P = 0.002) hospitals. CONCLUSIONS We conclude that implementing the DIP payment reform yields inconsistent consequences across different hospitals. DIP reform encouraged public hospitals and high-level hospitals to treat patients with higher illness severities and requiring high treatment intensity, resulting in a significant increase in total expenditure per case. The inconsistencies between public and private hospitals may be attributed to their different baseline levels prior to the reform and their different responses to the incentives created by the reform.
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Affiliation(s)
- Xue Tang
- School of Public Health, Fudan University, Shanghai, China
| | - Xinyu Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Yajing Chen
- School of Public Health, Fudan University, Shanghai, China
| | - Jiaqi Yan
- School of Public Health, Fudan University, Shanghai, China
| | - Mengcen Qian
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China.
- Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China.
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Fan W, Jiang Y, Pei J, Yan P, Qiu L. The impact of medical insurance payment systems on patient choice, provider behavior, and out‐of‐pocket rate: Fee‐for‐service versus diagnosis‐related groups. DECISION SCIENCES 2023. [DOI: 10.1111/deci.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Wenjuan Fan
- School of Management Hefei University of Technology Hefei China
- Key Laboratory of Process Optimization and Intelligent Decision‐making of Ministry of Education Hefei China
| | - Yuanyuan Jiang
- School of Management Hefei University of Technology Hefei China
- Key Laboratory of Process Optimization and Intelligent Decision‐making of Ministry of Education Hefei China
| | - Jun Pei
- School of Management Hefei University of Technology Hefei China
- Key Laboratory of Process Optimization and Intelligent Decision‐making of Ministry of Education Hefei China
| | - Ping Yan
- School of Management Hefei University of Technology Hefei China
- Key Laboratory of Process Optimization and Intelligent Decision‐making of Ministry of Education Hefei China
| | - Liangfei Qiu
- Department of Information Systems and Operations Management, Warrington College of Business University of Florida Gainesville FloridaUnited States
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Zhang JR, Wu YE, Huang YF, Zhang SQ, Pan WL, Huang JX, Huang QP. Effectiveness of smart health-based rehabilitation on patients with poststroke dysphagia: A brief research report. Front Neurol 2023; 13:1110067. [PMID: 36698875 PMCID: PMC9868154 DOI: 10.3389/fneur.2022.1110067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/16/2022] [Indexed: 01/10/2023] Open
Abstract
Objective This study aimed to evaluate the effectiveness of smart health-based rehabilitation on patients with poststroke dysphagia (PSD). Methods We recruited 60 PSD patients and randomly allocated them to the intervention (n = 30) and control (n = 30) groups. The former received the smart health-based rehabilitation for 12 weeks, whereas the latter received routine rehabilitation. Water swallow test (WST), standardized swallowing assessment (SSA), swallow quality-of-life questionnaire (SWAL-QOL), stroke self-efficacy questionnaire (SSEQ), perceived social support scale (PSSS) and nutritional measurements including body weight, triceps skinfold thickness (TSF), total protein (TP), serum albumin (ALB) and serum prealbumin (PA) in both groups were measured. Results When the baseline WST, SSA, SWAL-QOL, SSEQ, PSSS and nutritional measurements were examined, there was no significant difference between the intervention group and the control group (P > 0.05). After rehabilitation interventions, the WST and SSA scores in the intervention group were significantly lower than those in the control group (P < 0.01). The SWAL-QOL, SSEQ and PSSS scores in the intervention group were significantly higher than in the control group (P < 0.01). Compared with the control group, the intervention group showed an increase in the serum levels of PA (P < 0.01). However, no statistically significant difference existed between the intervention group and the control group in terms of body weight, TSF, TP or ALB (P > 0.05). Conclusions Overall, our data revealed that smart health-based rehabilitation is significantly beneficial to the swallowing function, quality of life, self-efficacy, and social support for PSD patients when compared with routine rehabilitation. However, nutritional measurements were not significantly improved in such patients under the smart health-based rehabilitation when compared the routine rehabilitation. In the future, it is necessary to extend the intervention time to further evaluate the long-term efficacy of smart health-based rehabilitation on nutritional measurements of PSD patients.
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Lu J, Lin Z, Xiong Y, Pang H, Zhang Y, Xin Z, Li Y, Shen Z, Chen W, Zhang W. Performance assessment of medical service for organ transplant department based on diagnosis-related groups: A programme incorporating ischemia-free liver transplantation in China. Front Public Health 2023; 11:1092182. [PMID: 37089494 PMCID: PMC10116067 DOI: 10.3389/fpubh.2023.1092182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
Background In July 2017, the first affiliated hospital of Sun Yat-sen university carried out the world's first case of ischemia-free liver transplantation (IFLT). This study aimed to evaluate the performance of medical services pre- and post-IFLT implementation in the organ transplant department of this hospital based on diagnosis-related groups, so as to provide a data basis for the clinical practice of the organ transplant specialty. Methods The first pages of medical records of inpatients in the organ transplant department from 2016 to 2019 were collected. The China version Diagnosis-related groups (DRGs) were used as a risk adjustment tool to compare the income structure, service availability, service efficiency and service safety of the organ transplant department between the pre- and post-IFLT implementation periods. Results Income structure of the organ transplant department was more optimized in the post-IFLT period compared with that in the pre-IFLT period. Medical service performance parameters of the organ transplant department in the post-IFLT period were better than those in the pre-IFLT period. Specifically, case mix index values were 2.65 and 2.89 in the pre- and post-IFLT periods, respectively (p = 0.173). Proportions of organ transplantation cases were 14.16 and 18.27%, respectively (p < 0.001). Compared with that in the pre-IFLT period, the average postoperative hospital stay of liver transplants decreased by 11.40% (30.17 vs. 26.73 days, p = 0.006), and the average postoperative hospital stay of renal transplants decreased by 7.61% (25.23 vs.23.31 days, p = 0.092). Cost efficiency index decreased significantly compared with that in the pre-IFLT period (p < 0.001), while time efficiency index fluctuated around 0.83 in the pre- and post-IFLT periods (p = 0.725). Moreover, the average postoperative hospital stay of IFLT cases was significantly shorter than that of conventional liver transplant cases (p = 0.001). Conclusion The application of IFLT technology could contribute to improving the medical service performance of the organ transplant department. Meanwhile, the DRGs tool may help transplant departments to coordinate the future delivery planning of medical service.
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Affiliation(s)
- Jianjun Lu
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuochen Lin
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Xiong
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Pang
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ye Zhang
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziyi Xin
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuelin Li
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqing Shen
- Center for Information Technology and Statistics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Wei Chen,
| | - Wujun Zhang
- Department of Quality Control and Evaluation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wujun Zhang,
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Zhang T, Lu B, Yan Z, Huang X, Lu W. Impacts of a New Episode-Based Payment Scheme on Volume, Expenditures, and Efficiency in Public Hospitals: A Quasi-Experimental Interrupted Time-Series Study in Jinhua, China. Risk Manag Healthc Policy 2022; 15:1659-1669. [PMID: 36092550 PMCID: PMC9462945 DOI: 10.2147/rmhp.s376516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/29/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose Based on the diagnosis-related groups payment, China developed an innovative episode-based payment scheme, called "payment method by disease types with point counting", to control health expenditures inflation. This study aimed to investigate the impacts of this new payment method on volume, expenditures, and efficiency in Chinese public hospitals. Methods The study sample consisted of 7 tertiary hospitals and 14 secondary hospitals in Jinhua (intervention group) and 4 tertiary hospitals and 14 secondary hospitals in Taizhou (control group). Monthly data points were collected for each sampled hospital from June 2016 to June 2019 using a self-administered questionnaire with impact evaluation indicators. Controlled interrupted time-series analysis was employed to estimate the effect of the new payment method. Results The significant slowing trends in inpatient expenditures per visit (tertiary hospitals: β7=-123.16, p=0.042; secondary hospitals: β7=-89.24, p=0.021) and out-of-pocket payments (tertiary hospitals: β7=-4.18, p=0.027; secondary hospitals: β7=-4.87, p=0.019) were observed after policy intervention. However, outpatient expenditures per visit in tertiary (β7=1.67, p=0.018) and secondary hospitals (β7=1.24, p=0.003) rose faster with the new payment method. Additionally, payment reform also caused an increase in the number of inpatient visits (β7=100.01, p=0.038) and reduced the length of stay (β7=-0.10, p=0.036) in tertiary hospitals. Conclusion The introduction of payment method by disease types with point counting causes the cost containment for inpatient care, whereas the increase in outpatient expenditures. The findings suggest this new payment scheme has the potential for rollout in other areas, but the cost-shifting from the inpatient to outpatient setting should be prevented.
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Affiliation(s)
- Tao Zhang
- Department of Health Policy and Management, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Beiyin Lu
- Department of Health Policy and Management, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Zhongheng Yan
- Office of the Vice President, Central Hospital of Hainan Province Western, Haikou, People’s Republic of China
| | - Xiaojun Huang
- School of Management, Hainan Medical University, Haikou, People’s Republic of China
| | - Wei Lu
- School of Management, Hainan Medical University, Haikou, People’s Republic of China,Department of Science and Education, Hainan Women and Children’s Health Care Centre, Haikou, People’s Republic of China,Correspondence: Wei Lu, School of Management, Hainan Medical University, No. 3 Xueyuan Road, Longhua District, Haikou, 5711993, People’s Republic of China, Tel +86 15971499800, Fax +8602767813016, Email
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Shi Y, Zhu P, Jia J, Shao Z, Yang S, Chen W, Zhang K, Tong W, Tian H. Cost-effectiveness of Same-day Discharge Surgery for Primary Total Hip Arthroplasty: A Pragmatic Randomized Controlled Study. Front Public Health 2022; 10:825727. [PMID: 35548067 PMCID: PMC9082643 DOI: 10.3389/fpubh.2022.825727] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Total hip arthroplasty (THA) causes a great medical burden globally, and the same-day discharge (SDD) method has previously been considered to be cost saving. However, a standard cost-effectiveness analysis (CEA) in a randomized controlled trial (RCT) is needed to evaluated the benefits of SDD when performing THA from the perspective of both economic and clinical outcomes. Methods Eighty-four participants undergoing primary THA were randomized to either the SDD group or the inpatient group. Outcomes were assessed by an independent orthopedist who was not in the surgical team, using the Oxford Hip Score (OHS), EuroQol 5D (EQ-5D), SF-36 scores and the quality-adjusted life years (QALYs). All the cost information was also collected. Results The mean stay of patients in the SDD group was 21.70 ± 3.45 h, while the inpatient group was 78.15 ± 26.36 h. This trial did not detect any significant differences in OHS and QALYs. The total cost in the SDD group was significantly lower than that in the inpatient group (¥69,771.27 ± 6,608.00 vs. ¥80,666.17 ± 8,421.96, p < 0.001). From the perspective of total cost, when measuring OHS, the incremental effect was -0.12 and the incremental cost was -¥10,894.90. The mean incremental cost-effectiveness ratio (ICER) was 90,790.83. When measuring QALYs, the incremental effect was 0.02, and the ICER was negative. Sensitivity analysis produced similar results. Conclusions SDD has an acceptable likelihood of being more cost-effective than the traditional inpatient option. After conducting cost-utility analysis, SDD resulted in better QALYs, while significantly reducing the total cost.
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Affiliation(s)
- Yangyang Shi
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peipei Zhu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Jia
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuhua Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Chen
- The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ke Zhang
- Biostatistician at Causality Clinical Data Technology Co., Ltd., Wuhan, China
| | - Wei Tong
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongtao Tian
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Meng Z, Zou K, Song S, Wu H, Han Y. Associations of Chinese diagnosis-related group systems with inpatient expenditures for older people with hip fracture. BMC Geriatr 2022; 22:169. [PMID: 35232376 PMCID: PMC8887083 DOI: 10.1186/s12877-022-02865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Hip fracture is frequent in older people and represents a major public health issue worldwide. The increasing incidence of hip fracture and the associated hospitalization costs place a significant economic burden on older patients and their families. On January 1, 2018, the Chinese diagnosis-related group (C-DRG) payment system, which aims to reduce financial barriers, was implemented in Sanming City, southern China. This study aimed to evaluate the associations of C-DRG system with inpatient expenditures for older people with hip fracture. Methods An uncontrolled before-and-after study employed data of all the patients with hip fracture aged 60 years or older from all the public hospitals enrolled in the Sanming Basic Health Insurance Scheme from January 1, 2016 to December 31, 2018. The ‘pre C-DRG sample’ included patients from January 1, 2016 to December 31, 2017. The ‘post C-DRG sample’ included patients from January 1, 2018 to December 31, 2018. A propensity score matching analysis was used to adjust the difference in baseline characteristic parameters between the pre and post samples. Data were analyzed using generalized linear models adjusted for the demographic, clinical, and institutional factors. Robust tests were performed by accounting for time trend, the fixed effects of the year and hospitals, and clustering effect within hospitals. Results After propensity score matching, we obtained two homogeneous groups of 1123 patients each, and the characteristic variables of the two matched groups were similar. We found that C-DRG reform was associated with a 19.51% decrease in out-of-pocket (OOP) payments (p < 0.001) and a 99.93% decrease in OOP payments as a share of total inpatient expenditure (p < 0.001); whereas total inpatient expenditure was not significantly associated with the C-DRG reform. All the sensitivity analyses did not change the results significantly. Conclusion The implementation of C-DRG payment system reduced both the absolute amount of OOP payments and OOP payments as a share of total inpatient expenditure for older patients with hip fracture, without affecting total inpatient expenditure. These results may provide significant insights for policymakers in reducing the financial burden on older patients with hip fracture in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02865-3.
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Affiliation(s)
- Zhaolin Meng
- School of Nursing, Capital Medical University, Beijing, China
| | - Kun Zou
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Suhang Song
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Huazhang Wu
- Department of Health Service Management, China Medical University, Shenyang, Liaoning, China
| | - Youli Han
- Department of Health Management and Policy, School of Public Health, Capital Medical University, NO 10, Xi Toutiao Rd Youanmenwai District, Beijing, 100069, China.
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Valentelyte G, Keegan C, Sorensen J. Analytical methods to assess the impacts of activity-based funding (ABF): a scoping review. HEALTH ECONOMICS REVIEW 2021; 11:17. [PMID: 34003386 PMCID: PMC8132407 DOI: 10.1186/s13561-021-00315-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/04/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Activity-Based Funding (ABF) has been implemented across many countries as a means to incentivise efficient hospital care delivery and resource use. Previous reviews have assessed the impact of ABF implementation on a range of outcomes across health systems. However, no comprehensive review of the methods used to generate this evidence has been undertaken. The aim of this review is to identify and assess the analytical methods employed in research on ABF hospital performance outcomes. METHODS We conducted a scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Five academic databases and reference lists of included studies were used to identify studies assessing the impact of ABF on hospital performance outcomes. Peer-reviewed quantitative studies published between 2000 and 2019 considering ABF implementation outside the U.S. were included. Qualitative studies, policy discussions and commentaries were excluded. Abstracts and full text studies were double screened to ensure consistency. All analytical approaches and their relative strengths and weaknesses were charted and summarised. RESULTS We identified 19 studies that assessed hospital performance outcomes from introduction of ABF in England, Korea, Norway, Portugal, Israel, the Netherlands, Canada, Italy, Japan, Belgium, China, and Austria. Quasi-experimental methods were used across most reviewed studies. The most commonly used assessment methods were different forms of interrupted time series analyses. Few studies used difference-in-differences or similar methods to compare outcome changes over time relative to comparator groups. The main hospital performance outcome measures examined were case numbers, length of stay, mortality and readmission. CONCLUSIONS Non-experimental study designs continue to be the most widely used method in the assessment of ABF impacts. Quasi-experimental approaches examining the impact of ABF implementation on outcomes relative to comparator groups not subject to the reform should be applied where possible to facilitate identification of effects. These approaches provide a more robust evidence-base for informing future financing reform and policy.
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Affiliation(s)
- Gintare Valentelyte
- Structured Population and Health services Research Education (SPHeRE) Programme, Division of Population Health Sciences, Mercer Street Lower, Royal College of Surgeons in Ireland, Dublin, Ireland
- Healthcare Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conor Keegan
- Economic and Social Research Institute (ESRI), Whitaker Square, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
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Chen J, Yang L, Qian Z, Sun M, Yu H, Ma X, Wan C, Yang Y. Cluster analysis of differences in medical economic burden among residents of different economic levels in Guangdong Province, China. BMC Health Serv Res 2020; 20:988. [PMID: 33115445 PMCID: PMC7594465 DOI: 10.1186/s12913-020-05817-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background This study compares and analyzes the differences of residents’ medical economic burden in different economic levels, explores the factors for improving the equity of health services in Guangdong, China. Methods Cluster analysis was carried out in 20 cities of Guangdong Province by taking 7 key factors on the equity of health services as indicators. Seven key factors were collected from Guangdong Statistical Yearbook 2017 and the Sixth National Population Census. R-type clustering was used to reduce the dimensionality of 7 candidate variables through similarity index. Q-type clustering was used to classify 20 cities in Guangdong Province. Results The cluster analysis divided Guangdong Province into three regions with different medical economic burden. The greater the proportion of the elderly over 65 years old, the greater the proportion of health care expenditure to per capita consumer expenditure of residents, and the heavier the medical economic burden. On average, 10.75% of the general budget expenditure of each city in Guangdong Province is spent on health care. Conclusions The lower per capita GDP, the higher proportion of the elderly over 65 years old and the lack of medical technicians are risk factors for the heavier medical burden of the residents and the fairness of health services. While increasing the health expenditure, the government needs to further complete the reform of the medical and health system, improve the efficiency of the medical system and curb the rapid rise of absolute health expenditures of individuals, which can reduce the economic burden of residents’ medical care.
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Affiliation(s)
- Jialong Chen
- School of Public Health, Guangdong Medical University, Dongguan, 523808, China
| | - Liuna Yang
- School of Public Health, Guangdong Medical University, Dongguan, 523808, China
| | - Zhenzhu Qian
- Guangdong Medical University, No.1 Xincheng Blvd, Songshan Lake National Hightech Industrial Development Zone, Dongguan, 523808, Guangdong, China
| | - Mingwei Sun
- School of Public Health, Guangdong Medical University, Dongguan, 523808, China
| | - Honglin Yu
- School of Public Health, Guangdong Medical University, Dongguan, 523808, China
| | - Xiaolei Ma
- Guangdong Medical University, No.1 Xincheng Blvd, Songshan Lake National Hightech Industrial Development Zone, Dongguan, 523808, Guangdong, China
| | - Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, 523808, China
| | - Yunbin Yang
- Guangdong Medical University, No.1 Xincheng Blvd, Songshan Lake National Hightech Industrial Development Zone, Dongguan, 523808, Guangdong, China.
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