Statistical Insight into China’s Indigenous Diagnosis-Related-Group System Evolution
Abstract
:1. Introduction
2. Materials and Methods
2.1. Primary Data Collection
2.2. Secondary Data from Published Literature
2.2.1. Search Strategy and Selection Criteria
2.2.2. Data Extraction
3. Results
3.1. Study Selection
3.2. Characteristics of the Included Publications
3.3. Efficiency of SDP
3.4. Factors Influencing Cholecystitis Expense in SDP
First Author | Province | LOS | Complication | Age | Gender | Operation | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
β | β′ | Sig | β | β′ | Sig | β | β′ | Sig | β | β′ | Sig | β | β′ | Sig | ||
Jiang (2019) [28] | Shandong | 5.560 | 0.000 | 0.089 | 0.047 | 0.195 | 0.030 | −4.655 | 0.000 | |||||||
He (2015) [26] | Yunnan | 0.109 | 0.289 | 0.000 | 0.031 | 0.076 | 0.001 | 0.023 | 0.055 | 0.006 | 0.001 | 0.073 | 0.001 | −0.290 | −0.294 | 0.000 |
Gu (2013) [24] | Tianjin | 0.011 | 0.373 | <0.001 | 0.024 | 0.034 | 0.040 | 0.002 | 0.097 | <0.001 | 0.019 | 0.037 | 0.030 | −0.285 | −0.544 | <0.001 |
Feng (2010) [23] | Beijing | 1.720 | 0.392 | 0.000 | 0.906 | 0.092 | 0.000 | 0.028 | 0.164 | 0.000 | 0.101 | 0.008 | 0.001 | 1.255 | 0.123 | 0.000 |
Chen (2006) [22] | Beijing | 0.001 | 0.431 | 0.000 | 0.000 | 0.062 | 0.000 | 0.001 | 0.062 | 0.000 | ||||||
Guo (2004) [25] | Anhui | 1.853 | 0.310 | 0.000 | 0.080 | 0.084 | 0.050 | 3.460 | 0.122 | 0.004 |
3.5. The Way of DRG Grouping Cholecystitis
3.6. The Efficiency of DRG in Cholecystitis-Related Disorders
3.7. Efficiency of DRG
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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First Author | Disease/Operation | Province | Number | Total Expenditure (RMB) | LOS (Day) | |||||
---|---|---|---|---|---|---|---|---|---|---|
Post- SDP | Pre- SDP | Post- SDP | Pre- SDP | p Value | Post- SDP | Pre- SDP | p Value | |||
Tang (2019) [9] | Laparoscopic cholecystectomy | Shandong | 266 | 202 | 13,858.32 | 21,699.15 | 0.00 | 4.70 | 8.31 | 0.02 |
Sun (2019) [12] | Laparoscopic cholecystectomy | Hunan | 75 | 260 | 10,533.79 | 13,355.16 | <0.01 | 5.00 | 6.00 | <0.01 |
Zhou (2018) [17] | Cholelithiasis with acute cholecystitis (Operation) | Yunnan | 27 | 30 | 5859.34 | 6264.37 | 0.05 | 6.49 | 7.47 | 0.16 |
Zhou (2018) [17] | Cholelithiasis with acute cholecystitis (No Operation) | Yunnan | 44 | 51 | 3473.20 | 3537.37 | 0.66 | 5.48 | 6.06 | 0.03 |
Zhang (2018) [18] | Laparoscopic cholecystectomy | Liaoning | 3864 | 4037 | 21,738.00 | 24,304.00 | <0.01 | 10.10 | 10.23 | 0.35 |
Chen (2016) [10] | Cholelithiasis with acute cholecystitis | Anhui | 755 | 940 | 5550.80 | 6026.00 | 0.00 | 6.55 | 9.04 | 0.00 |
Sun (2015) [11] | Laparoscopic cholecystectomy | Jiangsu | 23 | 23 | 9372.58 | 11,653.52 | <0.05 | 7.13 | 9.85 | <0.05 |
Wang (2013) [13] | Laparoscopic cholecystectomy | Shandong | 50 | 50 | 4073.35 | 9887.13 | <0.01 | 5.00 | 13.00 | <0.01 |
Yu (2012) [15] | Laparoscopic cholecystectomy | Jilin | 88 | 119 | 12,534.38 | 16,716.18 | <0.01 | 5.00 | 7.00 | <0.01 |
Kong (2011) [14] | Laparoscopic cholecystectomy | Jiangsu | 100 | 100 | 3989.34 | 6321.88 | <0.05 | 4.40 | 6.80 | <0.05 |
Su (2011) [21] | Laparoscopic cholecystectomy | Hunan | 383 | 516 | 5017.84 | 11,355.93 | <0.01 | 8.20 | 12.85 | 0.00 |
Liu (2009) [19] | Laparoscopic cholecystectomy | Jilin | 139 | 163 | 8100.00 | 9900.00 | <0.01 | 5.80 | 8.20 | <0.01 |
Jiang (2009) [18] | Laparoscopic cholecystectomy | Hubei | 95 | 91 | 5483.83 | 6470.44 | <0.05 | 8.20 | 10.50 | <0.05 |
Ren (2006) [20] | Laparoscopic cholecystectomy | Hebei | 118 | 118 | 4390.00 | 5533.00 | <0.05 | 4.00 | 7.00 | <0.05 |
DRG Code | DRG Group | RW | Number of Cases |
---|---|---|---|
HS10B | Laparoscopic cholecystectomy without common bile duct exploration | 0.95 | 2006 |
HS10C | Laparoscopic cholecystectomy, day surgery | 0.95 | 2 |
HS09C | Open cholecystectomy without exploration of common bile duct or severe complications | 1.66 | 82 |
HS10A | Laparoscopic cholecystectomy with exploration of common bile duct | 1.75 | 78 |
HS10 + HO03 | Complex treatment of laparoscopic cholecystectomy + ERCP | 1.77 | 52 |
HS09A | Open cholecystectomy with exploration of common bile duct | 2.05 | 16 |
HS09B | Open cholecystectomy with exploration of common bile duct and severe complications | 2.05 | 8 |
DRG Groups | RW | Number | LOS (Days) | Total Expenditure (RMB) | |||||
---|---|---|---|---|---|---|---|---|---|
Pre- DRG | Post- DRG | Pre- DRG | Post- DRG | Difference | Pre- DRG | Post- DRG | Difference | ||
Major surgery of biliary tract, with malignant tumor | 2.54 | 28 | 50 | 18.54 | 16.52 | 2.02 | 80,940.56 | 80,544.06 | 396.50 |
Complex operations of ERCP, with severe complications and concomitants | 2.16 | 18 | 49 | 9.00 | 9.80 | −0.80 | 29,208.42 | 33,511.80 | −4303.38 |
Other minor hepatobiliary and pancreatic surgery | 2.09 | 37 | 124 | 9.41 | 5.07 | 4.34 | 18,188.37 | 13,832.44 | 4355.92 |
Percutaneous bile duct therapeutic procedure | 1.80 | 69 | 68 | 10.19 | 8.73 | 1.46 | 26,044.01 | 20,340.31 | 5703.70 |
Laparoscopic cholecystectomy, with exploration of common bile duct | 1.75 | 16 | 20 | 14.00 | 11.70 | 2.30 | 43,822.88 | 44,061.44 | −238.56 |
Laparotomic cholecystectomy, without exploration of common bile duct, without severe complications and concomitants | 1.66 | 18 | 17 | 13.56 | 15.18 | −1.62 | 48,591.35 | 54,390.31 | −5798.96 |
Major surgery of biliary tract, without malignant tumor, with moderate complications and concomitants | 1.46 | 10 | 13 | 14.20 | 13.77 | 0.43 | 43,288.88 | 53,139.44 | −9850.56 |
Complex operations of ERCP, without severe complications and concomitants | 1.38 | 81 | 149 | 8.37 | 7.23 | 1.14 | 25,374.83 | 24,181.43 | 1193.40 |
Major surgery of biliary tract, without malignant tumor, without complications and concomitants | 1.15 | 44 | 43 | 12.82 | 10.00 | 2.82 | 38,133.45 | 36,957.94 | 1175.50 |
Diagnostic operations of hepatobiliary system without severe complications and concomitants | 1.06 | 21 | 45 | 7.29 | 6.91 | 0.38 | 12,986.78 | 13,025.49 | −38.71 |
Laparoscopic cholecystectomy, without exploration of common bile duct | 0.95 | 540 | 804 | 7.49 | 6.21 | 1.28 | 23,612.10 | 22,852.57 | 759.53 |
Malignant tumor of liver, gallbladder, or pancreas, without severe complications and concomitants | 0.85 | 154 | 47 | 9.92 | 7.63 | 2.28 | 27,536.63 | 15,523.52 | 12,013.11 |
Acute biliary tract disease, with complications and concomitants | 0.81 | 14 | 16 | 7.89 | 7.69 | 0.20 | 16,830.59 | 16,415.66 | 414.93 |
Chronic biliary tract disease, with complications and concomitants | 0.70 | 18 | 22 | 6.66 | 5.32 | 1.34 | 10,504.02 | 8408.61 | 2095.41 |
Acute biliary tract disease, without complications and concomitants | 0.64 | 30 | 25 | 7.57 | 5.84 | 1.73 | 15,092.63 | 8649.21 | 6443.42 |
Chronic biliary tract disease, without complications and concomitants | 0.40 | 74 | 74 | 7.09 | 5.12 | 1.98 | 8267.54 | 6602.42 | 1665.12 |
First Author | DRGs | Province | Number | TE (RMB) | LOS (Day) | |||||
---|---|---|---|---|---|---|---|---|---|---|
Post- DRG | Pre- DRG | Post- DRG | Pre- DRG | p Value | Post- DRG | Pre- DRG | p Value | |||
Liu (2020) [29] | Local DRG | Henan | 9381 | 10,176 | 22,738 | 25,837 | <0.05 | 13.30 | 15.80 | <0.05 |
Meng (2020) [30] | CN-DRG | Guangdong | 439,114 | 300,538 | 5301 | 5633 | <0.001 | 8.85 | 8.81 | <0.001 |
Meng (2020) [30] | C-DRG | Guangdong | 232,255 | 300,538 | 5681 | 5633 | <0.001 | 8.70 | 8.81 | <0.001 |
Zhou (2022) [33] | Local DRG | Yunnan | 23,887 | 165,261 | 14,819 | 17,435 | <0.001 | N/A | N/A | N/A |
Tang (2020) [35] | CN-DRG | Beijing | 5982 | 2871 | 20,674 | 19,960 | 0.139 | 9.98 | 10.14 | 0.044 |
Zhou (2021) [37] | CHS-DRG | Zhejiang | 24,728 | 18,355 | 10,125 | 9720 | <0.01 | 7.00 | 7.00 | <0.01 |
Zhou (2019) [36] | Local DRG | Liaoning | 995 | 2165 | 19,048 | 17,510 | <0.01 | N/A | N/A | N/A |
Zhang (2022) [32] | Local DRG | Hubei | 62 | 65 | 12,437 | 18,032 | 0.058 | 8.19 | 8.80 | 0.058 |
Wu (2021) [31] | Local DRG | Sichuan | 12,019 | 11,533 | 8658 | 10,951 | <0.05 | 8.78 | 10.66 | <0.05 |
Zou (2020) [34] | C-DRG | Guangdong | 237 | 234 | 11,739 | 12,278 | 0.725 | 4.87 | 5.34 | 0.019 |
R&D Department | Year Published | Number of Groups (ADRG/DRGs) | RW | Character | |
---|---|---|---|---|---|
BJ-DRG | Beijing Medical Insurance Association | 2008 | 393/752 | Resource consumption | First localized DRG in China Focuses on expense control |
CN-DRG | Beijing Municipal Health Commission | 2014 | 415/804 | Total expense of disease consumption | Focuses on medical performance evaluation and quality supervision |
C-DRG | National Health Commission of the People’s Republic of China | 2015 | 455/958 | Total cost of disease consumption | Innovatively groups based on all disease spectra and CCHI |
CHS-DRG | National Healthcare Security Administration | 2019 | 367/618 | Total cost of disease consumption | Refers to and integrates all above versions |
SDP | DRG | DIP | |
---|---|---|---|
Payment | Prospective payment | Prospective payment | Prospective payment |
Data source | Medical records | Medical records | Medical records |
Grouping objects | Simple diseases with no comorbidities and complications | All diseases | All hospitalized patients |
Payment standard | Categories of disease | Groups and Relative Weights | Groups and budget point value |
Standardized | No | Only MDC and ADRG are standardized | Yes |
Grouping pathway | N/A | Induction | Exhaustive method |
Grouping basis | N/A | Clinical pathway | Clinical data |
Grouping refinement | N/A | Similar diagnoses and operations in one group | Different diseases and operations in different groups |
Intra-group differences | N/A | Significant | Insignificant |
Number of groups | N/A | Usually less than 1000 | More than 10,000 |
Requirement of medical record quality | Low | High | Low |
Applying difficulty | Easy | Hard | Easy |
Usage of big data | No | No | Yes |
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Ma, W.; Qu, J.; Han, H.; Jiang, Z.; Chen, T.; Lu, X.; Lu, J. Statistical Insight into China’s Indigenous Diagnosis-Related-Group System Evolution. Healthcare 2023, 11, 2965. https://doi.org/10.3390/healthcare11222965
Ma W, Qu J, Han H, Jiang Z, Chen T, Lu X, Lu J. Statistical Insight into China’s Indigenous Diagnosis-Related-Group System Evolution. Healthcare. 2023; 11(22):2965. https://doi.org/10.3390/healthcare11222965
Chicago/Turabian StyleMa, Wenlong, Jing Qu, Hui Han, Zixia Jiang, Tiantian Chen, Xuefeng Lu, and Jiaoyang Lu. 2023. "Statistical Insight into China’s Indigenous Diagnosis-Related-Group System Evolution" Healthcare 11, no. 22: 2965. https://doi.org/10.3390/healthcare11222965