DRG weight algorithm optimization in Beijing from the perspective of hospital performance evaluation
10.3760/cma.j.cn111325-20230927-00187
- VernacularTitle:医院绩效评价视角下的北京地区DRG权重算法优化研究
- Author:
Yelong QIU
1
;
Moning GUO
;
Yin CHEN
;
Jianxiong MA
;
Airan DONG
;
Tinghui FU
Author Information
1. 首都医科大学宣武医院绩效运营办，北京 100053
- Keywords:
Diagnosis-related groups;
Weight;
Algorithms;
Hospitals;
Performance evaluation
- From:
Chinese Journal of Hospital Administration
2024;40(7):563-567
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To optimize the diagnosis-related groups (DRG) weight calculation method based on the perspective of hospital performance evaluation and the high-quality development orientation of public hospitals.Methods:Using the first page data of 3 256 701 inpatient medical records from secondary and tertiary hospitals in Beijing from January to December 2021, three algorithms including payment DRG weight, five-category DRG weight, and optimized DRG weight were used to calculate the weights of each DRG, and the differences between different algorithms were analyzed. The case-mix index (CMI) of the entire hospital and the clinical specialties to which the key DRG belongs in secondary and tertiary hospitals was calculated by using the three DRG weight algorithms, to reflect the performance evaluation results of different algorithms.Results:The results of one-way ANOVA showed that there was a significant difference ( P=0.019) among the three DRG weight algorithms. Comparing the optimized DRG weight with the payment DRG weight, the weight of BD29 (neural stimulator implantation or removal surgery) in the key DRG decreased from 7.77 to 4.61, and the weight of LA19 (renal tumor surgery) increased from 2.06 to 2.58; Compared with the five-category DRG weight, the weight of ES31 (respiratory infection/inflammation with severe complications or comorbidities) decreased from 2.36 to 1.72, and the weight of CB39 (crystalloid surgery) increased from 0.22 to 0.30. Comparing the use of optimized DRG weights and five-category DRG weights to calculate CMI, all types of hospitals and clinical specialties showed varying degrees of improvement in CMI. The CMI of tertiary hospitals increased from 1.02 to 1.20, and the CMI of secondary hospitals increased from 0.88 to 0.95. The difference in CMI between secondary and tertiary hospitals was even more pronounced. Conclusions:Optimized DRG weights could better reflect the value of medical technology compared with the payment DRG weights. Compared to five-category DRG weights, optimized DRG weights could better reflect the differences in CMI of different levels of hospitals.
