An Initial Study of Evaluating and Controlling Decomposed Hospitalization under DRG Payment
- VernacularTitle:DRG付费模式下评价及控制分解住院方法探索
- Author:
Haimei XIE
1
;
Xue GONG
;
Yunhong WANG
;
Jinfeng WANG
;
Xinbing LÜ
Author Information
1. 首都医科大学附属北京潞河医院质效部 北京 101149
- Keywords:
Diagnosis Related Groups Payment;
decomposed hospitalization;
readmission rate
- From:
Chinese Health Economics
2024;43(3):72-77
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Evaluate the occurrence of repeated hospitalizations during the DRG payment reform of a tertiary general hospital and attempt to establish an operational method for evaluating decomposed hospitalization.Methods:The relevant data of inpa-tients in a tertiary public hospital in Beijing from November 1,2020,to August 31,2023,were collected,the occurrence of repeated hospitalization before and after the DRG reform were compared,and the suspicious decomposed hospitalization groups were screened and analyzed.Results:After the DRG reform,the incidence of 14-day,7-day,3-day,and same-day repeated hospitalization increased significantly compared with that before the reform(P＜0.05).Malignancies of the digestive system,a disease with a high readmission rate in the four categories,had a consistency of 6.02％in the ADRG group for two adjacent repeated hospitalizations,and the subsequent admissions of this disease may be assigned to different DRG groups for payment settlement.Conclusion:It is crucial to further enhance the medical insurance payment system,clarify criteria for"decomposed hospitalization",reduce the supervision cost of decomposed hospitalization,and prioritize management strategies targeting avoidable unplanned readmissions.
