Objective:To analyse the impact of diagnosis-related groups (DRG) payment reform on the length of stay and hospitalisation expenses of patients in pilot medical institutions of Beijing, for references for the formulation and optimisation of DRG payment related policies.Methods:The home page data of inpatient medical records from 56 medical institutions that implemented DRG payment in Beijing from April to October 2021 (before DRG payment reform) and April to October 2022 (after DRG payment reform). Patients participating in the basic medical insurance for urban employees in Beijing were selected as the reform group, and others served as the control group. The difference-in-differences model (DID) were used to analyse the related indicators, to evaluate the effectiveness of the reform.Results:This study comprised a total of 3 294 003 inpatients. Of them, 1 714 134 cases were in the control group (911 100 cases before the reform and 803 034 cases after) and 1 579 869 cases were in the study group (802 899 cases before the reform and 776 970 cases after). The gender, age composition and treatment methods of patients changed little before and after the reform. But the proportion of patients with severe comorbidities or complications rose from 11.11% before the reform to 13.19% after the reform. Through the analysis of the DID model, the DRG payment reform could reduce the length of stay ( P=0.001) and hospitalization expenses of patients ( P<0.001), and played a certain optimising role in the cost structure. Among them, the proportion of medical service expenses did not change significantly ( P=0.977), the proportion of inspection and testing expenses, as well as drug expenses decreased slightly ( P=0.001, P=0.004), and the proportion in consumable expenditures increased slightly ( P=0.001). Conclusions:DRG payment reform played a positive role in shortening the length of stay and hospitalization expenses. It was suggested that medical institutions in Beijing should further optimize the structure of patient hospitalization expenses, with a focus on exploring effective ways to increase the medical service revenue and reasonably control the consumables costs.

Objective:To analyse the impact of diagnosis-related groups (DRG) payment reform on the length of stay and hospitalisation expenses of patients in pilot medical institutions of Beijing, for references for the formulation and optimisation of DRG payment related policies.Methods:The home page data of inpatient medical records from 56 medical institutions that implemented DRG payment in Beijing from April to October 2021 (before DRG payment reform) and April to October 2022 (after DRG payment reform). Patients participating in the basic medical insurance for urban employees in Beijing were selected as the reform group, and others served as the control group. The difference-in-differences model (DID) were used to analyse the related indicators, to evaluate the effectiveness of the reform.Results:This study comprised a total of 3 294 003 inpatients. Of them, 1 714 134 cases were in the control group (911 100 cases before the reform and 803 034 cases after) and 1 579 869 cases were in the study group (802 899 cases before the reform and 776 970 cases after). The gender, age composition and treatment methods of patients changed little before and after the reform. But the proportion of patients with severe comorbidities or complications rose from 11.11% before the reform to 13.19% after the reform. Through the analysis of the DID model, the DRG payment reform could reduce the length of stay ( P=0.001) and hospitalization expenses of patients ( P<0.001), and played a certain optimising role in the cost structure. Among them, the proportion of medical service expenses did not change significantly ( P=0.977), the proportion of inspection and testing expenses, as well as drug expenses decreased slightly ( P=0.001, P=0.004), and the proportion in consumable expenditures increased slightly ( P=0.001). Conclusions:DRG payment reform played a positive role in shortening the length of stay and hospitalization expenses. It was suggested that medical institutions in Beijing should further optimize the structure of patient hospitalization expenses, with a focus on exploring effective ways to increase the medical service revenue and reasonably control the consumables costs.

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.

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.

Objective:To evaluate the relationship between silence information regulator 1 (SIRT1) and NOD-like receptor protein 3 (NLRP3) inflammasomes during myocardial ischemia-reperfusion (I/R) in diabetic rats.Methods:SPF-grade healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 200-220 g, were used in this study.Type 1 diabetes mellitus was induced by intraperitoneal 1% streptozotocin diluted in citrate buffer solution 60 mg/kg.The rats were continuously fed for 8 weeks after successful establishment of the model.Forty-two rats with type 1 diabetes mellitus were divided into 4 groups by a random number table method: diabetic sham operation group (DS group, n=6), diabetic myocardial I/R group (DIR group, n=12), diabetic myocardial I/R plus SIRT1 agonist SRT1720 group (DIR+ SR group, n=12) and diabetic myocardial I/R plus SIRT1 inhibitor EX-527 group (DIR+ EX group, n=12). Eighteen non-diabetic rats were divided into 2 groups by a random number table method: non-diabetic sham operation group (NS group, n=6) and non-diabetic myocardial I/R group (NIR group, n=12). The myocardial I/R model was established by ligation of the left anterior descending coronary artery for 30 min followed by 120-min reperfusion in anesthetized rats.Blood samples were collected from the carotid artery immediately after the end of reperfusion for determination of serum troponin I (cTnI), creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) levels (by enzyme-linked immunosorbent assay). Then the rats were sacrificed, and myocardial tissues were obtained for determination of myocardial infarct size (by TTC method) and expression of SIRT1, NLRP3 and IL-1β (by Western blot) and for microscopic examination of pathological changes of myocardial tissues (by HE staining). The percentage of myocardial infarct size was calculated. Results:Compared with group NS, the serum levels of cTnI, CK-MB and LDH were significantly increased, the expression of SIRT1 in myocardial tissues was down-regulated, and the expression of NLRP3 and IL-1β was up-regulated in group NIR ( P<0.05). Compared with group DS, the serum levels of cTnI, CK-MB and LDH were significantly increased, the expression of SIRT1 in myocardial tissues was down-regulated, and the expression of NLRP3 and IL-1β was up-regulated in group DIR ( P<0.05). Compared with group NIR, the percentage of myocardial infarct size and serum levels of cTnI, CK-MB and LDH were significantly increased, the expression of SIRT1 in myocardial tissues was down-regulated, the expression of NLRP3 and IL-1β was up-regulated ( P<0.05), and the pathological changes were accentuated in group DIR.Compared with group DIR, the percentage of myocardial infarct size and serum levels of cTnI, CK-MB and LDH were significantly decreased, the expression of SIRT1 in myocardial tissues was up-regulated, the expression of NLRP3 and IL-1β was down-regulated ( P<0.05), and the pathological changes were significantly attenuated in group DIR+ SR, and the percentage of myocardial infarct size and serum levels of cTnI, CK-MB and LDH were significantly increased, the expression of SIRT1 in myocardial tissues was down-regulated, the expression of NLRP3 and IL-1β was up-regulated ( P<0.05), and the pathological changes were accentuated in group DIR+ EX. Conclusion:The up-regulated expression of SIRT1 can inhibit the activation of NLRP3 inflammasomes and produces endogenous protection during myocardial I/R in diabetic rats.

Objective:To study the influence of the choice of main diagnosis on diagnosis-related groups(DRG) grouping and weight change, by taking cerebral infarction as the entry point.Methods:From January 1, 2019 to March 31, 2019, 331 patients in three DRG groups(BR25, BR23, BR21) with cerebral infarction were selected. The original group was used as the control group; the main diagnosis was exchanged with the first other diagnosis, then DRG group was used as the experimental group. The difference of the number of cases and weight between the two groups was analyzed.Results:41.4%(137/331) of the patients in the experimental group were enrolled in BZ11 with other neurological disorders associated with important comorbidities and comorbidities, and 82.5%(273/331) patients′ weight increased after diagnostic conversion.Conclusions:Choosing other diagnosis as the main diagnosis may change the weight of the disease and affect the corresponding disease benefit. In order to prevent downcoding, DRG grouping should be detailed, and DRG payment should consider how to reflect the value of difficult cases; for upcoding behavior, medical insurance center and relevant medical institutions should check the correctness of coding, and monitor in place.

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.

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.