Zhu Tingting, Chen Chun, Zhang Xinxin, Yang Qingren, Hu Yipao, Liu Ruoyun, Zhang Xiangyang, Dong Yin
Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China.
BMJ Open. 2024 Mar 12;14(3):e073913. doi: 10.1136/bmjopen-2023-073913.
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.
A longitudinal study using a robust multiple interrupted time series model to evaluate service performance following policy implementation.
Twenty-two public general hospitals (8 tertiary institutions and 14 secondary institutions) in Wenzhou, China.
The intervention was implemented in January 2020.
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.
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).
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.
本研究衡量了基于诊断相关分组（DRG）的点数付费政策实施后住院绩效的差异。点数是动态的；其变化取决于年度DRG成本结算和当年点数，这些在次年年初计算。
一项纵向研究，使用稳健的多重中断时间序列模型评估政策实施后的服务绩效。
中国温州的22家公立综合医院（8家三级医院和14家二级医院）。
干预于2020年1月实施。
指标包括病例组合指数（CMI）、每次住院费用（CPH）、平均住院日（ALOS）、成本效率指数（CEI）和时间效率指数（TEI）。本研究采用这些指标的均值。
2020年1月底疫情蔓延至浙江省，在严格防控措施下疫情迅速得到控制，其影响是暂时的。干预后，除ALOS均值外，三级和二级医院其他结局的变化点（p<0.05）不一致。与之前相比，三级医院（p<0.01）和二级医院（p<0.0001）的CMI均值呈上升趋势。虽然CPH均值的斜率没有变化（p>0.05），但三级医院CEI均值的上升趋势有所缓解（p<0.05），二级医院则进一步上升（p<0.05）。二级医院ALOS和TEI均值的斜率发生了变化（p<0.05），但三级医院没有变化（p>0.05）。
本研究表明，即使在新冠肺炎疫情期间，DRG政策在温州也产生了积极效果。该政策可激励公立综合医院提高其综合能力，并减少类似疾病治疗费用效率的差异。政策制定者关注改革是否成功激励医院增强内部动力并改善绩效，本研究支持了这一点。
