Acquisition standard of medical record homepage and impact on BJ-DRGs grouping / 中华医院管理杂志

BJ-DRGs grouping process was cited as an example, to describe the factors affecting the grouping process, grouping results and assessment results, and the solutions in transferring homepages into WJT form 4-1 for inpatient medical record homepages (WJT form 4-1 for short).Authors analyzed how to better information acquisition quality of such homepages by unifying the data interface standard of WJT form 4-1, for the purposes of enhancing BJ-DRGs grouping efficiency, and expanding its functions as a tool for medical quality management and that for medical insurance payment management.

Progress and implications of the DRG-based prospective payment system ( DRG-PPS ) reform in China / 中国卫生政策研究

DRG-based prospective payment system ( DRG-PPS ) is one type of mature inpatient care payment mechanisms in most countries and pilot projects would be introduced to China in 2017. This article provides an overview of the previous typical DRG-PPS reform initiatives on provincial, municipal and county level respectively. It also summa-rizes the characteristics of the reform programs, describes the diversities of policy implementation, and discusses the suc-cessful experience and implications of the initiatives. The paper puts forward some suggestions on the upcoming DRG-PPS pilot projects based on the progress and problems of the initiatives, to promote the DRG-PPS reform in China.

Adjusted cost consumption index of major diagnosis-related group data in hospital medical performance evaluation / 中华医院管理杂志

Objective To study the calculation of the cost consumption index adjusted with major diagnostic classification (MDC), for optimal use of DRGs index in hospital performance evaluation. Methods The adjustment method of CMI value in DRGs index system was used as reference, and we compared the different cost consumption indexes(both MDC adjusted and non-adjusted) of two hospitals(S and Y) in Guangdong province. Then we compared the different rankings of 82 tertiary general hospitals in the province before and after the adjustment. Results The cost consumption index of S hospital was higher than that of Y hospital by the non-adjusted method (1.30 >1.28). But as calculated by the adjusted method,the index of S hospital was significantly lower than Y hospital (1.31 <1.38). The rankings of these 82 hospitals also showed major changes,which prove that the cost consumption index, the same as CMI,will be affected by MDC cases makeup.Conclusions The MDC adjusted cost consumption index, when applied to hospital performance evaluation, renders more stable and reasonable results. This is an evidence that the adjusted cost consumption index is of great practical value in hospital performance evaluation.

The challenge and solution for the front page of inpatient medical record based on DRGs / 中华医院管理杂志

This article discussed the development, challenge and solution for the front page of inpatient medical record based on DRGs (diagnosis related groups).It will facilitate the stakeholders' understanding, unifying the standard of data, building quality control system, improving the quality of the front page of medical record.Thus, the information in the front page will contribute to the scientific evaluation of health service ability and quality for hospital.

Application of Diagnosis Related Groups evaluation index in performance management system of hospitals / 中华医院管理杂志

Objective To explore the use of Diagnosis Related Groups(DRGs)evaluation index in performance management system of hospitals.Methods The performance evaluation system was built based on medical business volume index,efficiency indicators,cost control indexes,drug control indexes, medical quality and medical safety indexes,by means of extracting the home page of hospital discharge records from 2009 to 2013 and grouping automatically with the“BJ-DRGs”group-maker.Results The operation evaluation indexes of the hospital have seen great progress since advent of the DRGs evaluation indexes.Conclusion Introduction of DRGs has scored great success in the performance appraisal system of the hospital.

DRGs in China: development, application and promotion / 中华医院管理杂志

Introducing the progress of DRGs work in Beijing, its application in medical insurance payment, as well as in hospital management and appraisal.Recommendations were made for DRGs development in the country, including unification of DRGs standards nationwide, orchestrated efforts of government departments, and acceleration of DRGs use in payment mode reforms.

DRGs-based medical performance evaluation of tertiary hospitals in Yunnan / 中华医院管理杂志

Objective To identify objective methods for medical service performance evaluation,and means to improve the efficiency of medical services.Methods By means of collection of medical records from 10 tertiary hospitals in Yunnan in 2012,and Diagnosis-related groups of Beijing version(BJDRGs)as a risk-adjustment tool,medical service performance was made to such hospitals.Results The capacity,efficiency and medical safety of hospital of the hospitals were subject to a comprehensive evaluation of their medical service capabilities.In terms of discharged inpatients and total weight,hospital A were found to be the highest(77 458 cases,104 227.5 respectively),and hospital I the lowest(25 450 cases,38 162.28)among these hospitals in 2012; compared with other hospitals,DRG groups of hospitals A,b and D were found higher,while the case mix index(CMI)of hospitals e and I were higher.The expenditure index of hospital C is the lowest(0.9359,0.8514); the mortality in cases of low risk of hospitals B,c and D were the lowest,while hospital F was the highest.Conclusion DRGs as a risk adjustment tool,can significantly improve the reliability,science and continuity of medical service performance evaluation,providing reliable basic data for hospitals accreditation in Yunnan.

DRGs-based methodology for medical performance evaluation and case studies / 中华医院管理杂志

Authors described characteristics of medical service performance evaluation,and strategy options for scientifically evaluating such performance,and systematically presented the conditions and methodology of DRGs-based evaluation of medical service performance.Six evaluation indicators were cited in terms of the capacity,efficiency and medical safety of medical service providers,with detailed introduction to the computation process of such indicators.Cases in hand indicate that the first-page data completeness and accuracy of medical records are preconditions for using DRGs in medical service performance evaluation.

DRGs-based expense analysis of inpatients with respiratory system diseases / 中华医院管理杂志

Objective To reasonably provide data basis of the expense standard for diagnosis related groups(DRGs)of respiratory system disease.Methods Use the first-page data of the medical records of 19,285 respiratory inpatients of a hospital.Use the Chi-squared Automatic Interaction Detector in the decision tree model to establish the inpatient case mix plan of respiratory disease inpatients.Then evaluate the model effectiveness with the variance reduction Results Expense median of the respiratory disease inpatients is 1603.97 yuan,averaging 2806.03 yuan,and the discretion degree is high.Proportion of surgical operations in respiratory disease is 3.89％,less than the others.Age is an important factor of respiratory disease for their hospitalization costs.Classification nodes of respiratory diseases are in turn the first discharge diagnosis,age,and secondary diagnosis.Patients were divided into 5 categories and 29 disease diagnosis related groups by such nodes.Conclusion Appropriate discharge diagnosis is the basis for building diagnosis related groups.Such variables as disease severity related variables as age and secondary diagnosis should serve as classification variables for respiratory system diseases.

Study of designing the standard interval for hospitalization costs based on clinical pathway / 中华医院管理杂志

Objective To set the cost standards for hospitalization based on the eases of the clinical pathway in order to help set a reasonable ceiling for the expenses of various diseases.Methods The multiple linear regression analysis was applied to find out influencing factors of hospitalization costs of the hysteromyoma.Diagnosis Related Groups(DRGs)ease mix was used to group 1777 hysteromyoma cases.Results The main factors for the expenses,as listed by their influence,were surgical operation or not,disease(s)of concomitance and the amount,adjusted R2 =0.6545.Hysteromyoma patients were divided into four diagnosis related groups; the all coefficient of variation(CV)is as small as 0.068,0.104,0.102,and 0.116 respectively.The hospitalization costs of the hysteromyoma of standard reference value were then calculated.Conclusion The standards interval for hospitalization costs set with DRGs case mix is reasonable and efficient,significantly useful for regulating medical practice and harnessing excessive costs of hospitalization.

Evaluating to Beijing diagnosis related groups / 中华医院管理杂志

ObjectiveTo evaluate the performance of diagnosis-related groups,Beijing version (BJ-DRGs) which were locally developed in Beijing.MethodA total of 1.3 million inpatient records from 149 hospitals in Beijing in 2008 were drawn from Beijing Public Information Center.Coefficient of variation (CV) was used to measure the performance of DRGs system.ResultsBJ-DRGs produced the best CV results for expenditure.ConclusionsUnder Beijing's medical information condition,BJ-DRGs produced good performance.

An initial study of identifying and controlling episode separations / 中华医院管理杂志

ObjectiveTo imitate the process of identifying episode separations,which helps to improve the methodology of control episode separations.Methods Abstracts of inpatient record on all patients discharged from the hospitals in Beijing in 2010 were drawn from Beijing Public Health Information Center.Risk-adjusted by Diagnosis Related Groups-Beijing version (BJ-DRGs),two-weeks readmission rate was calculated at the whole city and hospital levels respectively.Comparing the readmission rate between these two levels,“suspicious objects”of episode separations can be found.In turn,the episode separations can be identified by detail analysis of these suspicious objects.Results In 2010,there were 13 DRGs with readmission rate exceeding 10％.Take the cases of dementia and other chronic brain disorders for example,the readmission rate for this type of inpatients in hospital G was much higher than the average level of the whole city.After the detail analysis of hospital G,the episode separations were found.Conclusion It is an effective method to indentify episode separations that calculating readmission rate based on the DRG risk-adjustment and using city level readmission rate as bench-mark.

Evaluation of clinical blood transfusion management using DRGs / 中华医院管理杂志

ObjectiveBy analyzing the transfusion-related data using DRGs data to establish a credible evaluation system for clinical use,thereby enhancing the safe and effective clinical transfusion management.Methods Use the transfusion-related data of DRG-s,and statistical methods of EXCEL database to categorize and analyze the number of blood transfusion,hospital name,hospital type,hospital level,DRGs code and name,times of blood transfusion,volume of transfusion,etc.Results Output the statistics of the city's ratio of institutional use of blood,per capita consumption in patients,distribution and ordering of hospital based blood tranfusion,distribution and ordering of DRGs based blood transfusion,distribution and ordering of single DRGs between hospitals,annual consumption growth in different hospitals and major disease groups of blood tranfusion.ConclusionThe use of DRGs can efficiently control clinical indicators for blood transfusion and evaluate the performance of blood transfusion.it can provide a credible management tool for the health administrative departments and hospitals while offering data support for policy making of management objectives at the same time.