Objective:This study assessed the role of the attending medical team in the cost control of the cholecystectomy DRG components.Methods:The association between team structure,workflow,and treatment outcomes was analyze...Objective:This study assessed the role of the attending medical team in the cost control of the cholecystectomy DRG components.Methods:The association between team structure,workflow,and treatment outcomes was analyzed using a mixed-methods approach combining quantitative data and qualitative interviews from 628 patients.Results:Inter-professional teamwork significantly affected length of stay,treatment costs,and recurrence rates,with experienced teams performing better in terms of emergency response and collaborative efficiency.Patient satisfaction was generally high,indicating that good teamwork enhances treatment outcomes.Significance:The study highlights the importance of optimizing team configuration to improve the quality,efficiency,and cost control of healthcare.展开更多
BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the s...BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance.Colorectal cancer(CRC),as a common malignant tumor with high prevalence in recent years,was among the 300 disease types.AIM To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs,and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.METHODS The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system.A variance analysis of the composition of medical expenditure was carried out,and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance.A decision tree model based on the exhaustiveχ^2 automatic interaction detector(E-CHAID)algorithm for DRG grouping was built by setting chosen factors as separation nodes,and the payment standard of each diagnostic group and upper limit cost were calculated.The correctness and rationality of the data were re-evaluated and verified by clinical practice.RESULTS The average hospital stay of the 1026 CRC patients investigated was 18.5 d,and the average hospitalization cost was 57872.4 RMB yuan.Factors including age,gender,length of hospital stay,diagnosis and treatment,as well as clinical operations had significant influence on inpatient expenditure(P<0.05).By adopting age,diagnosis,treatment,and surgery as the grouping nodes,a decision tree model based on the E-CHAID algorithm was established,and the CRC patients were divided into 12 DRG cost groups.Among these 12 groups,the number of patients aged≤67 years,and underwent surgery and chemotherapy or radiotherapy was largest;while patients aged>67 years,and underwent surgery and chemotherapy or radiotherapy had the highest medical cost.In addition,the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated.CONCLUSION It is important to strengthen the control over the use of drugs and management of the hospitalization process,surgery,diagnosis and treatment to reduce the economic burden on patients.Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.展开更多
本研究探讨了疾病诊断相关分组(diagnosis related groups,DRG)系统在新疆地区住院患者疾病负担中的应用。通过对现有DRG系统的局限性进行深入分析,研究提出针对新疆地区的系统优化策略。利用大数据分析技术,研究整合并分析新疆多家医...本研究探讨了疾病诊断相关分组(diagnosis related groups,DRG)系统在新疆地区住院患者疾病负担中的应用。通过对现有DRG系统的局限性进行深入分析,研究提出针对新疆地区的系统优化策略。利用大数据分析技术,研究整合并分析新疆多家医院的住院数据,通过实证案例,验证了优化后DRG系统在疾病分类、资源分配和费用控制方面的有效性。结果显示,优化后的DRG系统能够更加精准地反映新疆地区的医疗需求,提升了医疗服务的质量与效率。研究还探讨了DRG系统在新疆进一步发展的方向与重点,指出加强大数据处理能力和算法的精准度是未来发展的关键。展开更多
目的分析按疾病诊断相关分组(DRG)付费下胃癌患者分组效果及住院费用影响因素,为DRG付费改革提供参考。方法采用变异系数(Coefficient of Variation,CV)和总体方差减少系数评价DRG分组效果;采用结构变动值和结构变动度分析不同DRG组住...目的分析按疾病诊断相关分组(DRG)付费下胃癌患者分组效果及住院费用影响因素,为DRG付费改革提供参考。方法采用变异系数(Coefficient of Variation,CV)和总体方差减少系数评价DRG分组效果;采用结构变动值和结构变动度分析不同DRG组住院费用结构变动情况,通过灰色关联度分析计算次均住院费用的关联程度;采用非参数检验和多元线性回归分析住院费用的影响因素。结果DRG分组效果不佳,组间异质性不够明显;住院费用结构不合理,耗材费占比过高,排在住院费用灰色关联度首位,综合医疗服务费、治疗费分别排在第三、五位;影响住院费用的主要因素是治疗方式、住院日、是否伴有并发症、是否首次住院,差异有统计学意义(P<0.05)。结论应增加分组节点或提高CV标准,增强胃癌DRG分组效果;优化住院费用结构,体现医务人员劳动和技术价值;加强内部管理,控制不合理药品、耗材使用。展开更多
China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limit...China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limited,especially for critical diseases such as leukemia.This places heavy economic burdens on patients.Under these circumstances,systems innovation is imperative for the efficient utilization of limited funding.In this respect,certain valuable experience from other countries may prove helpful.The prospective payment system of Diagnosis-related Groups(DRGs),Clinical Paths,and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence(NICE,UK),can befine tools to reduce medical costs and improve quality of services.Treatments of acute promyelocytic leukemia at Rui-Jin Hospital,and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center,can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases,and to satisfactorily justify the feasibility of DRGs in China.展开更多
文摘Objective:This study assessed the role of the attending medical team in the cost control of the cholecystectomy DRG components.Methods:The association between team structure,workflow,and treatment outcomes was analyzed using a mixed-methods approach combining quantitative data and qualitative interviews from 628 patients.Results:Inter-professional teamwork significantly affected length of stay,treatment costs,and recurrence rates,with experienced teams performing better in terms of emergency response and collaborative efficiency.Patient satisfaction was generally high,indicating that good teamwork enhances treatment outcomes.Significance:The study highlights the importance of optimizing team configuration to improve the quality,efficiency,and cost control of healthcare.
文摘BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance.Colorectal cancer(CRC),as a common malignant tumor with high prevalence in recent years,was among the 300 disease types.AIM To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs,and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.METHODS The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system.A variance analysis of the composition of medical expenditure was carried out,and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance.A decision tree model based on the exhaustiveχ^2 automatic interaction detector(E-CHAID)algorithm for DRG grouping was built by setting chosen factors as separation nodes,and the payment standard of each diagnostic group and upper limit cost were calculated.The correctness and rationality of the data were re-evaluated and verified by clinical practice.RESULTS The average hospital stay of the 1026 CRC patients investigated was 18.5 d,and the average hospitalization cost was 57872.4 RMB yuan.Factors including age,gender,length of hospital stay,diagnosis and treatment,as well as clinical operations had significant influence on inpatient expenditure(P<0.05).By adopting age,diagnosis,treatment,and surgery as the grouping nodes,a decision tree model based on the E-CHAID algorithm was established,and the CRC patients were divided into 12 DRG cost groups.Among these 12 groups,the number of patients aged≤67 years,and underwent surgery and chemotherapy or radiotherapy was largest;while patients aged>67 years,and underwent surgery and chemotherapy or radiotherapy had the highest medical cost.In addition,the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated.CONCLUSION It is important to strengthen the control over the use of drugs and management of the hospitalization process,surgery,diagnosis and treatment to reduce the economic burden on patients.Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.
文摘本研究探讨了疾病诊断相关分组(diagnosis related groups,DRG)系统在新疆地区住院患者疾病负担中的应用。通过对现有DRG系统的局限性进行深入分析,研究提出针对新疆地区的系统优化策略。利用大数据分析技术,研究整合并分析新疆多家医院的住院数据,通过实证案例,验证了优化后DRG系统在疾病分类、资源分配和费用控制方面的有效性。结果显示,优化后的DRG系统能够更加精准地反映新疆地区的医疗需求,提升了医疗服务的质量与效率。研究还探讨了DRG系统在新疆进一步发展的方向与重点,指出加强大数据处理能力和算法的精准度是未来发展的关键。
文摘目的分析按疾病诊断相关分组(DRG)付费下胃癌患者分组效果及住院费用影响因素,为DRG付费改革提供参考。方法采用变异系数(Coefficient of Variation,CV)和总体方差减少系数评价DRG分组效果;采用结构变动值和结构变动度分析不同DRG组住院费用结构变动情况,通过灰色关联度分析计算次均住院费用的关联程度;采用非参数检验和多元线性回归分析住院费用的影响因素。结果DRG分组效果不佳,组间异质性不够明显;住院费用结构不合理,耗材费占比过高,排在住院费用灰色关联度首位,综合医疗服务费、治疗费分别排在第三、五位;影响住院费用的主要因素是治疗方式、住院日、是否伴有并发症、是否首次住院,差异有统计学意义(P<0.05)。结论应增加分组节点或提高CV标准,增强胃癌DRG分组效果;优化住院费用结构,体现医务人员劳动和技术价值;加强内部管理,控制不合理药品、耗材使用。
基金supported in part by the Program of Improving Health Services in China’s Rural Areas supported by the World Bank Loans(Qinghai Province,QHWST-2009KT01).
文摘China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limited,especially for critical diseases such as leukemia.This places heavy economic burdens on patients.Under these circumstances,systems innovation is imperative for the efficient utilization of limited funding.In this respect,certain valuable experience from other countries may prove helpful.The prospective payment system of Diagnosis-related Groups(DRGs),Clinical Paths,and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence(NICE,UK),can befine tools to reduce medical costs and improve quality of services.Treatments of acute promyelocytic leukemia at Rui-Jin Hospital,and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center,can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases,and to satisfactorily justify the feasibility of DRGs in China.
