With building up a clinical modification system model by upgrading the standard disease classification system architecture,to collect those huge amount of diagnosis names and codes in use,based on the model to screen and coordinate the relation of them,the tenth revision of the International Classification of Disease Clinical Modification of Beijing is implemented.This standard has been successfully applied for two years in all those secondary and above level hospitals in Beijing.It could well support the work of deploying Diagnosis Related Groups in Beijing and support not only those traditional applications of disease classification but also those new and advance requirements of information processing.

Objective Taking the respiratory department of internal medicine as an example, to compare the coverage of clinical treatment of the MDC covered by DRGs of Beijing version with the professional services offered as secondary clinical treatment subjects in China.Methods Using the data from medical record home page from hospitals in Beijing above secondary level from 2012 to 2014 and both the DRGs defined in Pareto diagram statistical method and the DRGs proved by experts, for analysis and definition of the DRGs coverage involved by respiratory discipline of internal medicine.Results Respiratory discipline of internal medicine involved DRGs of 42 groups as found by the two methods.Conclusion The DRGs scope of secondary clinical departments in hospitals should be made based on both expert consultation and clinical data statistics method.

Collection and quality control of inpatient medical record home page information are key to the study and use of DRGs.The paper covered the sampling methods, inspection items, inspection methods, data assembly methods, and data reporting quality scoring methods of Beijing authorities on the hospitals in the city.Also introduced were the inspection results of the city in 2014, which prove a satisfactory outcome in the end.

Objective To analyze the applicability of case mix index (CMI) in medical performance evaluation of different type of hospitals and its calculation method.Methods Standardized adjustment to the CMI value of hospitals according to the CMI of the main disease categories (MDC) of short-term inpatient cases of the city, to align the CMI values of various hospitals with their levels of medical and technical services.Results The said adjustment ensures the CMI value to better represent the levels of such hospitals.Conclusion The adjusted CMI calculation method can provide accurate data support for various hospitals' performance evaluation.

Objective To analyze the inpatient specialist capacity of a hospital during 2013-2014 in Beijing for its specialists development, based on relevant local specialist development.Methods Analyzing the inpatient specialist capacity using case mix index (CMI) and DRG numbers according to BJ-DRG grouping method.Each MDC of the hospital is divided into four types according to the status and development of inpatient specialist capacity.Results Of the 19 MDCs, 2 (such as nervous system disease) fall into type 1, 6 MDCs (such as neck, ears, nose, mouth, pharynx disease and dysfunction) into type 2, while 5 MDCs (such as female reproductive system diseases and dysfunction) into type 3, and 6 MDCs (such as pregnancy, childbirth and postpartum) into type 4.Condusion Most of the MDC inpatient specialist capacities of the hospital in question are at ranking high in Beijing, and such capacities for various MDC can be improved by all means.

Objective To use diagnosis related group (DRGs ) for the first time in overall evaluation of inpatient service performance evaluation of major diagnostic category (MDC)for all the Beijing municipal hospitals,and recommend how to strengthen Beijing municipal hospitals system in diagnosis and treatment ability of main diseases and improve inpateint service performance.Methods BJ-DRGs burster software was used to analyze the first page information of the medical records of cases discharged from all the Beijing municipal hospitals between 2012 and 2014 to determine the weight of each DRG,and based on such weight the related indicators of such hospitals and central hospitals in 2012, 2013,2014 were compared and analyzed.Results Improvements were found in such indices as diagnosis and treatment difficulty of 50% MDC,time efficiency of 81.8% MDC,cost efficiency of 77.3% MDC, and general capacity of 54.5% MDC for all Beijing municipal hospitals.In addition,the municipal hospitals were found superior to the central hospitals in such indices as cost efficiency of 68.2% MDC, and time efficiency of 59.1% MDC.On the other hand however,they were found inferior to the central hospitals in such indices as diagnosis and treatment difficulty of 72.7% MDC,and the comprehensive ability index of the two systems were found equivalent.Another finding was that there was no obvious improvement of the coverage of disease types at major tertiary hospitals in Beijing for the past three years.Municipal hospitals of greater contribution of MDC weight were highly consistent with the hospitals assigned with national key projects of disciplinary developments. Conclusion The comprehensive evaluation results of inpatient service performance of main diseases at Beijing’s municipal hospitals based on DRGs system,showed that the Beijing’s hospital authority had played an important role in improving inpatient service performance especially in reducing the burden of patients,improving the service efficiency through increasing government investment,optimizing service organization and implementation of performance management.But it also suggested that measures such as collectivize construction and management should be taken to improve municipal hospitals’linical specialty ability, improve the MDC diagnosis and treatment difficulty,and resume their functions of tertiary hospitals.

OBJECTIVETo observe the changes of hospitalization rates and in-hospital mortality for coronary heart disease (CHD) in Beijing from 2007-2012.

METHODSPatients hospitalized for CHD in Beijing from 1 January 2007 to 31 December 2012 were identified from"The Cardiovascular Disease Surveillance System in Beijing". In total, 421 929 patients aged ≥25 years of permanent Beijing residents were admitted for CHD in Beijing during the 6 years. After excluding duplicate records and validation for the completeness and accuracy of the records, the hospitalization rates for CHD and in-hospital CHD mortality were analyzed. Trends in hospitalization rates and the in-hospital mortality for CHD were analyzed with Poisson regression models.

RESULTSThe age-standardized average hospitalization rate of CHD was 515.3 per 100 000 population in patients aged ≥25 years in Beijing. During the six years, an increasing trend was observed in the hospitalization rates for CHD after adjusting the age and gender (P<0.001). The age-standardized hospitalization rates of CHD increased by 43.0% in the past six years. The greatest increases of hospitalization rates were noted in both men and women between 45 to 54 years. The age-standardized in-hospital mortality decreased from 3.3% to 2.2% over the time (P<0.001), with a in-hospital mortality reduction for acute myocardial infarction from 11.3% to 8.5%.

CONCLUSIONSAn increasing trend in hospitalization rate was observed during 2007-2012 for Beijing residents aged ≥25 years, indicating an urgent need in CHD prevention in Beijing. The in-hospital mortality reduction during this period might reflect the improvement in the in-hospital treatment modalities of CHD.

Objective To improve overall value of healthcare industry through setting up critical inpatient medical services strategic plan.Methods Identify major objectives which the local government expects to achieve through strategic map; Standardize inpatient output and assign weight to each group through diagonosis related groups; Translate the objectives of strategic map and result of diagnosis related group to Balanced Score-card; Finally build up strategic map and according action plans.ResultsPreliminarily established 16 objectives、23 measures and 13 tasks in four perspectives including customer,internal work flow,learning and growing and finance.ConclusionThe strategy map and the balanced score-card can help implement full strategic plan of regional inpatient medical services; DRGs is a core management tool of patient-centred service output management; Balanced Score-card is able to realize continuous improvement of Beijing inpatient medical services from macro to micro persoetive.

Objective:To evaluate the effect of the comprehensive reforms of clinic-pharmacy separation and medical-consumables expenditure linkage in Beijing.Methods:Monitoring data of the comprehensive reforms were collected from 363 public medical institutions in Beijing between January 2016 and December 2019, while descriptive analysis and interrupted times series analysis using segmented regression models were adopted to analyze the influence of the two reforms on medical expense and its structure. We also studied the impact mechanism of service utilization and service price factors on medical expense control.Results:During the period from 2016 to 2019, the medical expenditure of public medical institutions in Beijing increased steadily at an annual growth rate of 4.4%-7.2%. The proportion of drug expense decreased from 44.6% in 2016 to 34.6% in 2019, while the proportion of medical service expense rose from 15.6% in 2016 to 24.3% in 2019, the proportion of examination and laboratory test expenses respectively showed a significant decline in April 2017 and June 2019. These two months witnessed respectively the launch of the two comprehensive reforms. Service utilization played an important role in controlling outpatient and emergency expenses, and service price was the key factor for controlling inpatient expenditure.Conclusions:The implementation of the two reforms in Beijing has effectively curbed the unreasonable growth of medical expenditure, and the expense structure has been constantly optimized and labor value of medical staff gradually improved.

Objective:To evaluate the medical service quality of psychiatric hospitals in Beijing based on diagnostic related group (DRG), analyze the evaluation effect, for refences to constructe a DRG performance evaluation system suitable for psychiatric hospitals.Methods:This study extracted data such as the number of DRG groups, etc. of hospitalized patients in 14 tertiary and secondary psychiatric hospitals in Beijing from 2018 to 2020 from the Beijing inpatient medical performance evaluation platform, and analyzed data on DRG performance evaluation indicators, as well as the average length of hospital stay and average cost of DRG enrolled cases. All data were analyzed using descriptive research methods, and inter group comparisons were conducted using the Mann Whitney U-test. Results:From 2018 to 2020, the average number of DRG groups in tertiary hospitals (28) was higher than that in secondary hospitals (10) ( P<0.05), and the average CMI values of both were the same(1.79); The average cost consumption index (1.15) of tertiary hospitals was higher than that of secondary hospitals (0.65) ( P<0.05), while the average time consumption index (1.11) was slightly lower than that of secondary hospitals (1.30); The mortality rate of the low-risk group in tertiary hospitals (0.01%) was generally lower than that in secondary hospitals (0.88%), and the average percentage of DRG admitted inpatients (82.8%) was significantly higher than that in secondary hospitals (27.3%) ( P>0.05). The average length of stay and cost per case for DRG enrolled inpatients in tertiary and secondary hospitals were lower than the overall hospital discharge cases ( P<0.05). Conclusions:The number of DRG groups, CMI value, and low-risk mortality rate could be used for evaluating the medical service capacity and safety of psychiatric hospitals, but the cost and time consumption index could not objectively reflect the efficiency of hospital medical services. DRG performance evaluation indicators are more suitable for evaluating short-term hospitalization of psychiatric patients. The proportion of DRG enrolled cases might be a potential indicator for evaluating the service quality of psychiatric hospitals.