School of Public Health, Fudan University, Shanghai, China.
Inquiry. 2023 Jan-Dec;60:469580231167011. doi: 10.1177/00469580231167011.
The aim of this meta-analysis was to comprehensively evaluate the effectiveness of Diagnosis-related group (DRG) based payment on inpatient quality of care. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science from their inception to December 30, 2022. Included studies reported associations between DRGs-based payment and length of stay (LOS), re-admission within 30 days and mortality. Two reviewers screened the studies independently, extracted data of interest and assessed the risk of bias of eligible studies. Stata 13.0 was used in the meta-analysis. A total of 29 studies with 36 214 219 enrolled patients were analyzed. Meta-analysis showed that DRG-based payment was effective in LOS decrease (pooled effect: SMD = -0.25, 95% CI = -0.37 to -0.12, = 3.81, < .001), but showed no significant overall effect in re-admission within 30 days (RR = 0.79, 95% CI = 0.62-1.01, = 1.89, = .058) and mortality (RR = 0.91, 95% CI = 0.72-1.15, = 0.82, = .411). DRG-based payment demonstrated statistically significant superiority over cost-based payment in terms of LOS reduction. However, owing to limitations in the quantity and quality of the included studies, an adequately powered study is necessary to consolidate these findings.
本荟萃分析的目的是全面评估按疾病诊断相关分组（DRG）支付对住院患者医疗质量的影响。我们在 PubMed、EMBASE、Cochrane 对照试验中心注册库和 Web of Science 上进行了全面的文献检索，检索时间从建库至 2022 年 12 月 30 日。纳入的研究报告了 DRG 支付与住院时间（LOS）、30 天内再入院和死亡率之间的关系。两名评审员独立筛选研究、提取相关数据，并评估合格研究的偏倚风险。使用 Stata 13.0 进行荟萃分析。共分析了 29 项研究，纳入了 36214219 名患者。荟萃分析表明，DRG 支付可有效降低 LOS（汇总效应：SMD=-0.25，95%CI=-0.37 至-0.12， =3.81， < .001），但在 30 天内再入院（RR=0.79，95%CI=0.62-1.01， =1.89， =0.058）和死亡率（RR=0.91，95%CI=0.72-1.15， =0.82， =0.411）方面无显著总体效应。DRG 支付在降低 LOS 方面表现出明显优于按成本支付的优势。然而，由于纳入研究的数量和质量存在局限性，需要进行一项充分有力的研究来整合这些发现。
