ABSTRACT
Objective This study aimed to investigate the factors influencing the personal burden rate incerebral ische-mic patients,compare the difference in the burden rate among the patients with varying degrees of cerebral ischemia,provide a reference for establishing a personal burden rate evaluation,and propose suggestions for control its increase.Methods The medi-cal insurance data were collected from 8164 discharged patients in a tertiary hospital in Tianjin between January and December 2022.With the data,the Generalized Linear Model was utilized to analyze the factors affecting the personal burden rate across different Diagnosis Related Groups(DRGs).Results Statistically significant differences were observed in the cost structure a-mong different DRGs.Age,length of hospital stays,total hospitalization cost,hospital admission mode,number of hospitaliza-tions,and type of medical insurance significantly impacted the personal burden rate.The personal burden rate was inversely cor-related with age and length of hospital stays,but directly correlated with the total hospitalization cost.The patients admitted from emergency,first-time hospitalization,and those covered by the basic medical insurance program for urban employees had a lower personal burden rate.Conclusion Hospitals should establish diverse personal burden rate performance evaluation standards for patients with different types of medical insurance,incorporating factors such as average length of hospital stays and average hospi-talization cost.A more equitable hospital internal assessment plan should be developed by considering patients admitted to differ-ent departments and aligning with the characteristics of clinical pathways.Medical institutions should minimize self-funded pro-jects under declared medical insurance,increase the enrollment of cases in DRGs,and promote tiered diagnosis and treatment to reduce the personal burden rate for patients.
ABSTRACT
Objective This study aims to investigate the application of the Plan-Do-Check-Act(PDCA)cycle in the Di-agnosis Related Group(DRG)payment system for oncological diseases.Methods We analyzed the factors influencing DRG pay-ment and incorporated the PDCA Cycle in the oncological diseases at a tertiary hospital in Tianjin.The baseline data of cases partic-ipating in DRG payment from April 2022 to September 2022 were compared with the settlement data of cases participating in DRG payment from October 2022 to March 2023.SPSS 20.0 was used to evaluate the impact of data quality in medical record documenta-tion on DRG admission rate,average hospitalization costs,average length of stay,Case Mix Index(CMI)value,and DRG settle-ment rate,so as to assess the effectiveness of the PDCA cycle in DRG payment within the oncological diseases at the hospital.Re-sults Following the PDCA cycle,the DRG admission rate increased from 84.03%to 89.98%,and the cases ineligible for inclu-sion decreased by 22.78%due to mismatched main diagnosis and procedures."Violations of the reporting and coding principles that do not require reporting"and"omission of primary surgical procedure codes"were no longer observed as reasons for failed DRG inclusion.Ambiguous cases with both average hospitalization costs and average length of stay higher than those of normal inclu-sion cases,leading to an increase in the average hospitalization cost from 22 496.56 yuan to 24714.92 yuan,and the average length of stay increased from 7.50 days to 8.13 days.The CMI value increased from 0.96 to 1.08,and the DRG settlement rate increased from 107.93%to 130.67%.Conclusion The PDCA cycle can effectively enhance the quality of medical record documentation,leading to improved quality in medical insurance settlement lists and DRG admission rates.It can help identify operational issues within the de-partment and promote the smooth implementation of DRG payment reform in the oncological department.
