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Zhu T, Chen C, Zhang X, Yang Q, Hu Y, Liu R, Zhang X, Dong Y. Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China. BMJ Open 2024; 14:e073913. [PMID: 38471900 DOI: 10.1136/bmjopen-2023-073913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES This study measures the differences in inpatient performance after a points-counting payment policy based on diagnosis-related group (DRG) was implemented. The point value is dynamic; its change depends on the annual DRGs' cost settlements and points of the current year, which are calculated at the beginning of the following year. DESIGN A longitudinal study using a robust multiple interrupted time series model to evaluate service performance following policy implementation. SETTING Twenty-two public general hospitals (8 tertiary institutions and 14 secondary institutions) in Wenzhou, China. INTERVENTION The intervention was implemented in January 2020. OUTCOME MEASURES The indicators were case mix index (CMI), cost per hospitalisation (CPH), average length of stay (ALOS), cost efficiency index (CEI) and time efficiency index (TEI). The study employed the means of these indicators. RESULTS The impact of COVID-19, which reached Zhejiang Province at the end of January 2020, was temporary given rapid containment following strict control measures. After the intervention, except for the ALOS mean, the change-points for the other outcomes (p<0.05) in tertiary and secondary institutions were inconsistent. The CMI mean turned to uptrend in tertiary (p<0.01) and secondary (p<0.0001) institutions compared with before. Although the slope of the CPH mean did not change (p>0.05), the uptrend of the CEI mean in tertiary institutions alleviated (p<0.05) and further increased (p<0.05) in secondary institutions. The slopes of the ALOS and TEI mean in secondary institutions changed (p<0.05), but not in tertiary institutions (p>0.05). CONCLUSIONS This study showed a positive effect of the DRG policy in Wenzhou, even during COVID-19. The policy can motivate public general hospitals to improve their comprehensive capacity and mitigate discrepancies in treatment expenses efficiency for similar diseases. Policymakers are interested in whether the reform successfully motivates hospitals to strengthen their internal impetus and improve their performance, and this is supported by this study.
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Affiliation(s)
- Tingting Zhu
- Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinxin Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qingren Yang
- School of Innovation and Entrepreneurship, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yipao Hu
- Health Information Center, Health Commission of Wenzhou, Wenzhou, Zhejiang, China
| | - Ruoyun Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiangyang Zhang
- Wenzhou Medical University First Affiliated Hospital, Wenzhou, Zhejiang, China
| | - Yin Dong
- Health Community Group of Yuhuan People's Hospital, Taizhou, Zhejiang, China
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Bonjour T, Waeber G, Marques-Vidal P. Trends in prevalence and outcomes of frailty in a Swiss university hospital: a retrospective observational study. Age Ageing 2021; 50:1306-1313. [PMID: 33453112 DOI: 10.1093/ageing/afaa278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Frailty complicates management and worsens outcomes. We assessed the prevalence, determinants and consequences of frailty among elderly patients in a hospital setting. DESIGN Retrospective observational study in a Swiss university hospital. METHODS 22,323 patients aged ≥65 years hospitalized between January 2009 and December 2017 at the internal medicine ward were included. Frailty was defined by the Hospital Frailty Risk Score (HFRS) and patients were categorized as low (HFRS<5), intermediate (HFRS 5-15) and high (HFRS>15) risk. RESULTS Overall prevalence of intermediate and high risk of frailty was 43% and 20%, respectively; prevalence was higher in women and increased with age. Prevalence of high risk of frailty increased from 11.4% in 2009 to 31% in 2012, and decreased to 19.2% in 2017. After multivariable adjustment, frailty was associated with increased length of stay: average and (95% confidence interval) 11.9 (11.7-12.1), 15.6 (15.4-15.8) and 19.7 (19.3-20.1) days for low, intermediate and high risk, respectively, and increased likelihood of ICU stay: odds ratio (OR) and (95% CI) 1.57 (1.41-1.75) and 2.10 (1.82-2.42) for intermediate and high risk, respectively, p for trend <0.001. Frailty was associated with increased likelihood of hospital costs >70,000 CHF: OR and (95% CI) 3.46 (2.79-4.29) and 10.7 (8.47-13.6) for intermediate and high risk, respectively, p for trend <0.001, and with a lower likelihood of complete cost coverage: OR and (95% CI) 0.70 (0.65-0.76) and 0.52 (0.47-0.58) for intermediate and high risk, respectively, p for trend<0.001. CONCLUSIONS Frailty is a frequent condition among hospitalized patients and is associated with higher costs.
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Affiliation(s)
- Thierry Bonjour
- Department of Medicine and Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Gérard Waeber
- Department of Medicine and Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine and Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Economic Implications of Chinese Diagnosis-Related Group-Based Payment Systems for Critically Ill Patients in ICUs. Crit Care Med 2021; 48:e565-e573. [PMID: 32317597 DOI: 10.1097/ccm.0000000000004355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the economic implications of payments based on Chinese diagnosis-related groups for critically ill patients in ICUs in terms of total hospital expenditure, out-of-pocket payments, and length of stay. DESIGN A pre-post comparison of patient cohorts admitted to ICUs 1 year before and 1 year after Chinese diagnosis-related group reform was undertaken. Demographic characteristics, clinical data, and medical expenditures were collated from a health insurance database. SETTING Twenty-two public hospitals in Sanming, Southern China. PATIENTS All patients admitted to ICUs from January 1, 2017, to December 31, 2018. INTERVENTION The implementation of Chinese diagnosis-related group-based payments on January 1, 2018. MEASUREMENTS AND MAIN RESULTS Economic variables (total expenditures, out-of-pocket payments, and length of stay) were calculated for each patient from the day of hospital admission to the day of hospital discharge. Adjusted mean out-of-pocket payment estimates were 29.46% (p < 0.001) lower following reform. Adjusted mean out-of-pocket payments fell by 41.32% for patients in neonatal ICU, whereas there were no significant decreases in out-of-pocket payments for patients in PICU and adult ICU. Furthermore, adjusted mean out-of-pocket payments decreased by 55.74% in secondary hospitals, but there was no significant change in tertiary hospitals after Chinese diagnosis-related group reform. No significant changes were found in total expenditures and length of stay. CONCLUSIONS Chinese diagnosis-related group policy provided an opportunity for critically ill patients in ICUs to achieve at least short-term financial benefits in reducing out-of-pocket payments, without affecting the total expenditures and length of stay. Chinese diagnosis-related group-based payment significantly relieved financial burdens for patients with lower illness severities, such as patients in neonatal ICU. The results of this study can offer significant insights for policymakers in reducing the financial burden on critically ill patients, both in China and in other countries with similar systems.
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Mongelli F, Lucchelli M, La Regina D, Christoforidis D, Saporito A, Vannelli A, Di Giuseppe M. Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:299-306. [PMID: 33953578 PMCID: PMC8088981 DOI: 10.2147/ceor.s306138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Background Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to perform a cost analysis on PNB use in in- and outpatients undergoing open hemorrhoidectomy. Methods From January 2018 to December 2019, patients undergoing open hemorrhoidectomy were included and randomized to undergo spinal anesthesia either with or without the PNB. Clinical data, direct and indirect costs for in- and outpatients, operating time and operating theatre occupancy were recorded. A cost-effectiveness analysis based on the diagnosis-related groups (DRG) and TARMED reimbursement systems was performed. Results Patients who underwent PNB in addition to spinal anesthesia had significantly less pain and a shorter length of hospital stay after open hemorrhoidectomy. The cost analysis included all 49 patients, 23 of whom, in addition to spinal anesthesia, received a PNB. There were no significant differences in operating theatre occupancy (p=0.662), mean operative time (p=0.610) or time required for anesthesia (p=0.124). Direct costs were comparable (482±386 vs 613±543 EUR, p=0.108), while indirect costs were significantly lower in the PNB group (2606±816 vs 2769±1506 EUR, p=0.005). We estimated an incremental cost-effectiveness ratio (ICER) of −243 ± 881 EUR/pain unit on the VAS. Conclusion Despite limitations, the ultrasound-guided PNB seems to reduce costs in patient undergoing open hemorrhoidectomy under spinal anesthesia. It was shown to be clinically beneficial and cost-effective, and therefore recommendable in patients undergoing open hemorrhoidectomy.
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Affiliation(s)
- Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Massimo Lucchelli
- Financial Department, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | | | - Andrea Saporito
- Department of Anesthesia, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | | | - Matteo Di Giuseppe
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
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Kollbrunner L, Rost M, Koné I, Zimmermann B, Padrutt Y, Wangmo T, Elger B. Acute and transitional care or rehabilitation? Retrospective analysis of discharge planning from a municipal hospital in Switzerland. BMC Health Serv Res 2020; 20:712. [PMID: 32746810 PMCID: PMC7397668 DOI: 10.1186/s12913-020-05547-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/15/2020] [Indexed: 11/27/2022] Open
Abstract
Background Due to rising health care costs, in 2012 Switzerland introduced SwissDRG, a reimbursement system for hospitals based on lump sum per case. To circumvent possible negative consequences like reduction in length of stay, acute and transitional care (ATC) was anchored into the law (Federal act on health insurance) in 2011. ATC as a discharge option is applicable to patients who physicians deem will not fulfill rehabilitation criteria, but are unable to return home and are in need of temporary professional nursing care. ATC is associated with higher out of pocket costs to the patient than rehabilitation. Since social service workers are responsible for organizing discharge for patients with ongoing care needs after hospitalization, the aim of this study was to investigate how social service workers manage patient discharge in light of the new discharge option ATC. Methods Data was collected from 423 medical records of inpatients from Zurich’s municipal hospital, Triemli, discharged to ATC or rehabilitation, in 2016. We compared the two groups using inferential statistics and qualitatively analyzed written statements from social service workers. Results Our results showed that patients discharged to rehabilitation had a higher total number of discussions, but a shorter duration of discussions. Patients discharged to rehabilitation faced more delays, mainly due to unavailability of beds in rehabilitation centers. Conflicts concerning discharge arose mainly because of costs, discharge placement and too early discharge. Conclusions Our findings demonstrate how important social service workers are in providing information to patients about different discharge options. The newness of SwissDRG and ATC is still likely to cause longer discussion times and, consequently, more workload for social service workers. Only a small fraction of patients disagreed with their place of discharge, mostly due to financial reasons.
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Affiliation(s)
- Lara Kollbrunner
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Bettina Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Yvonne Padrutt
- Institute of legal science, University of Zurich, Treichlerstrasse 10, 8032 Zürich, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Center for legal medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland
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Barouni M, Ahmadian L, Anari HS, Mohsenbeigi E. Investigation of the impact of DRG based reimbursement mechanisms on quality of care, capacity utilization, and efficiency- A systematic review. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1782663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mohsen Barouni
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Saberi Anari
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Mohsenbeigi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
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The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis. Health Policy 2020; 124:359-367. [DOI: 10.1016/j.healthpol.2020.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/25/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
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Wangmo T, Padrutt Y, Koné I, Gächter T, Elger BS, Leu A. Practicality of Acute and Transitional Care and its consequences in the era of SwissDRG: a focus group study. BMC Health Serv Res 2019; 19:374. [PMID: 31196075 PMCID: PMC6567569 DOI: 10.1186/s12913-019-4220-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/05/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Switzerland recently introduced Acute and Transitional Care (ATC) as a new financing option and a preventive measure to mitigate potential side effects of Swiss Diagnosis Related Group (SwissDRG). The goal of ATC was to support patients who after acute treatment at a hospital require temporary increased professional care. However, evidence is lacking as to the practicality of ATC. METHODS Using qualitative focus group methodology, we sought to understand the implementation and use of ATC. A purposive sample of forty-two professionals from five Swiss cantons participated in this study. We used a descriptive thematic approach to analyse the data. RESULTS Our findings first reveal that ATC's implementation differs in the five cantons (i.e. federal states). In two cantons, only ambulatory variant of ATC is used; in one canton only stationary ATC has been created, and two cantons had both ambulatory and stationary ATC but preferred the latter. Second, there are intrinsic practical challenges associated with ATC, which include physicians' lack of familiarity with ATC and its regulatory limitations. Finally, participants felt that due to shorter hospital stays because of SwissDRG, premature discharge of patients with complex care needs to stationary ATC takes place. This development does not fit the nursing home concept of care tailored to long-term patients. CONCLUSION This empirical study underscores that there is a strong need to improve ATC so that it is uniformly implemented throughout the country and its application is streamlined. In light of the newness of ATC as well as SwissDRG, their impact on the quality of care received by patients is yet to be fully understood. Empirical evidence is necessary to improve these two measures.
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Affiliation(s)
- Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Yvonne Padrutt
- Faculty of Law, University of Zurich, Zurich, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Thomas Gächter
- Faculty of Law, University of Zurich, Zurich, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Agnes Leu
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Department Health Sciences, Kalaidos University of Applied Sciences, Zurich, Switzerland
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