The Effects of Diagnosis-Related Group Payment on Diagnostic Cerebral Angiograms through a Transradial and Transfemoral Approach: A Comparative Observational Study

Background. Cerebral angiography is an X-ray examination technique widely used in hospitals. At present, it is mainly divided into two kinds of angiography examination: transfemoral artery and transradial artery puncture. The diagnosis-related group (DRG) system is a new type of payment standard recognized internationally, but its impact on medical care and health outcomes is currently controversial. Aim. In this study, we conducted a comparative study on two invasive approaches, transradial artery and transfemoral artery puncture and observed whether DRG had an impact on the quality of the medical process. Methods. We compared and analyzed patients undergoing cerebral angiography via the femoral artery and radial artery puncture by recording the relevant parameters and comfort scale scores (GCQ) during the operation, as well as postoperative complications. At the same time, we observed the proportion of different puncture routes and the success rate of cerebral angiography before and after the implementation of a DRG payment simulation. Results. The results of the comparative analysis of patients’ transradial artery and transfemoral artery puncture angiography showed that the puncture success rate (99.1% vs. 97.2%, P > 0.05 ), angiography success rate (97.3% vs. 95.1%, P > 0.05 ), and X-ray radiation time (4.82 vs. 5.15 min, P > 0.05 ) demonstrated no significant difference. The ambulation time (1.52 vs. 12.06 h, P < 0.05 ), puncture time (22.42 vs. 31.02 min, P < 0.05 ), and complications (3.57% vs. 9.03%, P < 0.05 ) of the radial artery group were significantly lower than those of the femoral artery group. In contrast, the GCQ score of the radial artery group at each stage after angiography was significantly higher than that of the femoral artery group ( P < 0.05 ). Compared with before the DRG simulation, the proportion of cerebral angiography with transradial artery puncture increased significantly after its implementation. Conclusion. Compared with transfemoral cerebrovascular angiography, transradial cerebrovascular angiography has many advantages, such as less local damage, less pain, less postoperative bed-rest time, significantly lower incidence of total complications, and a lower cost. Following the implementation of the DRG payment method, the quality of the angiography medical process improved.

Impact of Diagnosis-Related Group Payment System on the Variation in Hospitalization Expenditures: A Case-Control Study with a Propensity-Score-Matched Control Group

Background One of the important ways to reduce medical costs and improve quality of care is to enable physicians to provide standard medical services according to clinical guidelines, and the medical payment system is a significant means of guiding the behaviour of health service providers. This study aims to investigate whether the diagnosis-related group (DRG) payment system can improve the consistency of health services. Method Inpatients with three types of disease—chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI) and cerebral infarction (CI)—were enrolled from 25 county-level hospitals in a DRG pilot city in China. Inpatients from hospitals that implemented DRG payment were selected as the intervention group, and similar inpatient cases from hospitals that still implemented fee-for-services (FFS) payment were designated as the control group. A propensity matching score (PSM) was used for data matching to control for age, gender and disease severity. The variation of hospitalization expenditures and their trends before and after implementation of the DRG policy were described by using these matched samples. Results After DRG implementation, the standard deviation (SD) of hospitalization expenditures in the COPD, AMI and CI intervention groups decreased by 11094 yuan, 4833 yuan and 425 yuan, respectively, which were 5972, 2484, and 2938 yuan more than that in the control group. In each year after DRG implementation, the interquartile range (IQR) of hospitalization expenditures was smaller in DRG group than that in FFS group. In most years, the degree of variation in costs of the intervention group decreased more than that of the control group. The medians of hospitalization expenditures of the intervention groups were lower than the fixed cost, while most medians of the control groups were higher than the fixed cost. Conclusion A comparison of patients with similar demographics and disease characteristics revealed that patients in the DRG group experienced a smaller degree of variation in hospitalization expenditures, and indicated the expenditures had a tendency to become progressively more concentrated over time. It is suggested that DRG system can promote better consistency in health services and reduce medical costs.

Comparative study between admission, orthopaedic surgery, and economic trends during Covid-19 and non-Covid-19 pandemic in an Italian tertiary hospital: a retrospective review

Background The COVID-19 pandemic represents one of the most massive health emergencies in the last century and has caused millions of deaths worldwide and a massive economic and social burden. The aim of this study was to evaluate how the COVID-19 pandemic—during the Italian lockdown period between 8 March and 4 May 2020—influenced orthopaedic access for traumatic events to the Emergency Department (ER). Methods A retrospective review of the admission to the emergency room and the discharge of the trauma patients’ records was performed during the period between 8 March and 4 May 2020 (block in Italy), compared to the same period of the previous year (2019). Patients accesses, admissions, days of hospitalisation, frequency, fracture site, number and type of surgery, the time between admission and surgery, days of hospitalisation, and treatment cost according to the diagnosis-related group were collected. Chi-Square and ANOVA test were used to compare the groups. Results No significant statistical difference was found for the number of emergency room visits and orthopaedic hospitalisations (p < 0.53) between the year 2019 (9.5%) and 2020 (10.81%). The total number of surgeries in 2019 was 119, while in 2020, this was just 48 (p < 0.48). A significant decrease in the mean cost of orthopaedic hospitalisations was detected in 2020 compared (261.431 euros, equal to − 52.07%) relative to the same period in 2019 (p = 0.005). Although all the surgical performances have suffered a major decline, the most frequent surgery in 2020 was intramedullary femoral nailing. Conclusion We detected a decrease in traumatic occasions during the lockdown period, with a decrease in fractures in each district and a consequent decrease in the diagnosis-related group (DRG).

Economic impact of the Swiss Diagnosis-Related Group system on acute neurorehabilitation

Objective: To assess the economic impact of introducing the Swiss Diagnosis-Related Group (DRG)-financing system on the Acute Neurorehabilitation Unit (ANRU) of a University hospital in 2012 and to discuss the implications in 2020.Methods: A retrospective study using monocentric patient cohort and collecting anonymized data of consecutive patients admitted to the ANRU in 2012 and 2013. The characteristics, DRG A43Z, costs and revenues were retrieved from the hospital accounting system and allowed a comparison between the 2012 and 2013 groups of patients.Results: Forty-seven patients were included over the assessment period. In 2012, of the 23 patients admitted, 20 were coded A43Z, while in 2013, out of the 24 admissions, only eight had that specific code (p < .01). The average length of stay (LOS) increased from 45.5 days in 2012 to 49.5 days in 2013. Similarly, the average cost per patient increased by Swiss Franc (CHF) 19,994 over the two years, from CHF 183,634 in 2012 to CHF 194,629 in 2013. Finally, the average reimbursement per patient diminished by CHF 11,392, from CHF 193,153 in 2012 to CHF 181,760 in 2013.Conclusions: The negative impact on the cost–revenue balance is linked to both the increased cost of a longer stay and the decreased revenue due to less patients being coded A43Z. This study highlights the difficulties to justify funding of the complex care needed and to properly reflect patient burden in medico-administrative documents. Certainly, there is a need for a concerted effort to identify the services and resources needed within the DRG-system to guarantee the optimal management of acute neurorehabilitation.

Erstellung zuverlässiger Erythrozytenkonzentrat-Bedarfslisten für Operationen und Interventionen aus Data-Warehouse-Daten und der patientenbezogenen Chargendokumentation von Blutkomponenten

ZusammenfassungDas Versäumnis, transfusionsvorbereitende Diagnostik durchzuführen und eine ausreichende Anzahl von Blutkomponenten vor der Operation zu bestellen, führt zunehmend zu klinischen Notfällen und vermeidbaren Risiken für die Patienten. Die eigentlich obligatorische Erstellung von Blutbedarfslisten scheitert oft an der Verfügbarkeit geeigneter Daten. Das Universitätsklinikum Erlangen ist ein Krankenhaus der Tertiärversorgung mit 1400 Betten. Hier werden seit 2010 kontinuierlich alle relevanten Daten zur Interpretation von Mustern bei der Verwendung von Blutbestandteilen erhoben. Wir sind in der Lage, die klinischen Data-Warehouse-Komponenten der persönlichen Daten der Empfänger von Erythrozytenkonzentraten (EK), die Codes der stationären Patienten im G-DRG-System (G-DRG: German Diagnosis Related Group), ICD-Codes, OPS-Codes und die Daten der EK-Komponenten aus dem IT-System der Blutbank zu integrieren. Die erhaltenen DRGs, ICD-Codes und OPS-Codes werden mit den Daten des Blutkomponentenverbrauchs auf individueller Basis verknüpft. Analysen können sowohl im gesamten Krankenhaus als auch in Bezug auf bestimmte Abteilungen durchgeführt werden. Die laufende Verfeinerung der Datenbankabfragen verbessert die Fähigkeit, den Blutbedarf für Standardoperationen und Interventionen korrekt abzuschätzen. Die Ergebnisse weichen zum Teil erheblich von den Schätzungen der Operateure hinsichtlich der Wahrscheinlichkeit einer Transfusion ab, oftmals wird die Wahrscheinlichkeit einer Transfusion unterschätzt. Die korrekte Einhaltung der 10-prozentigen Transfusionswahrscheinlichkeitsgrenze für die Frage der frühen präoperativen Bereitstellung von Kreuzblut kann durch solche Abfragen verbessert werden. Dem Phänomen der „verzögerten Transfusion“ entgegenzuwirken, wird zu einer immer wichtigeren Aufgabe für den klinisch tätigen transfusionsmedizinischen Arzt. Die Erstellung von Statistiken über die Transfusionswahrscheinlichkeit durch die Verknüpfung von Data-Warehouse-Daten und Chargendokumentationsdaten aus Blutbanken kann die notwendigen Werkzeuge bereitstellen.