Analysis of trends in potentially inappropriate medication among elderly cancer patients in the context of DRG-based medical insurance payment reform
- VernacularTitle:医保DRG付费改革背景下老年肿瘤患者潜在不适当用药的变化趋势分析
- Author:
Yonghui LIU
1
;
Min ZHAO
2
;
Xiaolin ZHANG
3
;
Mingmei HUANG
2
;
Hongliang ZHANG
4
Author Information
1. School of Pharmacy，Guangxi Medical University，Nanning 530021，China;Dept of Pharmacy，Yulin City First People’s Hospital （The Sixth Affiliated Hospital of Guangxi Medical University），Guangxi Yulin 537000，China
2. Dept of Pharmacy，The First Affiliated Hospital of Guangxi Medical University，Nanning 530021，China
3. Dept of Pharmacy，Yulin City First People’s Hospital （The Sixth Affiliated Hospital of Guangxi Medical University），Guangxi Yulin 537000，China
4. School of Pharmacy，Guangxi Medical University，Nanning 530021，China
- Publication Type:Journal Article
- Keywords:
Elderly;
cancer patients;
potentially inappropriate medication;
DRG-based medical insurance payment reform;
interrupted time-series;
comorbidity
- From:
China Pharmacy
2026;37(18):2430-2436
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To analyze the trends of potentially inappropriate medication （PIM） among elderly cancer patients in the context of the diagnosis-related groups（DRG）-based medical insurance payment reform.METHODS Relevant data were extracted for elderly inpatients with cancer at a Grade-A Level-Ⅲ hospital from January 2018 to March 2025. Prescribed medications were screened for PIM using the 2024 Chinese Criteria for Identifying PIM in the Elderly and the US 2023 Beers Criteria， and consistency was evaluated. An interrupted time-series （ITS） model was established， with the period from January 2018 to December 2020 designated as the pre-implementation group， and January 2021 to March 2025 as the post-implementation group. The study analyzed the impact of the medical insurance DRG payment reform on per capita hospitalization costs， per capita length of stay， average number of medication specifications per patient， overall PIM incidence， and PIM incidences for target medications among elderly cancer inpatients. To eliminate the influence of baseline characteristics （age， sex）， propensity score matching（PSM） was further applied， followed by an ITS model analysis to assess the impact of the DRG payment reform on the overall PIM incidence among elderly cancer inpatients.RESULTS A total of 16 910 elderly cancer inpatients were included （6 552 in the pre-implementation group， and 10 358 in the post-implementation group）； PIMs occurred in 9 138 patients， with an incidence of 54.04%. PIMs involved 198 types of medications， among which six target medications （including Diclofenac sodium enteric capsules and Oxycodone hydrochloride sustained-release tablets）， exhibited a higher average PIM incidence or a significant trend change； the Kappa value for the consistency evaluation of the assessments by two pharmacists was 0.931 （ P ＜0.001） . After the implementation of DRG， the per capita hospitalization costs showed a downward trend of 103.501 yuan per month （ P ＜0.001）； the per capita length of stay showed a slight upward trend （increasing by 0.052 days per month， P ＝0.017）， but the actual slope （－0.036） was less than 0； there was no significant change in the average number of medication specifications per patient （ P ＝0.193）. The DRG payment reform under medical insurance can produce statistically significant instantaneous impact effects on the PIM incidences among users of Diclofenac sodium enteric capsules， Doxofylline injection， and Cimetidine injection （ P values of 0.041， 0.001， and 0.036， respectively）， a statistically significant long-term trend effect on the PIM incidences among users of Oxycodone hydrochloride sustained-release tablets （ P ＝0.008）， and statistically significant instantaneous shock and long-term trend effects on the PIM incidences among users of Spironolactone tablets （ P values of 0.035 and 0.031） and Aminophylline injection （ P values of 0.009 and 0.031）. Regardless of whether PSM was applied， the overall PIM incidence among patients showed a slight upward trend [an increase of 0.228% per month， P ＝0.001 （without PSM）， or an increase of 0.239% per month， P ＜0.001 （after PSM）].CONCLUSIONS Following the implementation of the DRG payment reform for medical insurance， the per capita hospitalization cost for elderly inpatients with cancer decreases significantly， while the decline in the per capita length of stay slows. The overall PIM incidence shows a slight upward trend， and the trends in PIM incidence vary across different drug formulations.
