Effects of diagnosis-related group payment on health-care provider behaviors: A consecutive three-period study

Hu, Wei-Yuan; Yeh, Ching-Fa; Shiao, An‐Suey; Tu, Tzong-Yang

doi:10.1016/j.jcma.2015.06.012

Cited by 26 publications

(26 citation statements)

References 17 publications

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“…The proportion of open CCY in the early CCY group is high, and this proportion helps to explain why the medical expenses are much higher in the early CCY group compared to the delayed CCY or no CCY groups. Our results support the two-stage treatment clinical pattern 29 under the current diagnosis-related group (DRG) charges (National Health Insurance) for cholelithiasis used in Taiwan.…”

Section: Discussionsupporting

confidence: 77%

Role of Cholecystectomy in Choledocholithiasis Patients Underwent Endoscopic Retrograde Cholangiopancreatography

Wang

Tsai

Yang

et al. 2019

Sci Rep

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There are no clinical guidelines for the timing of cholecystectomy (CCY) after performing therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. We tried to analyze the clinical practice patterns, medical expenses, and subsequent outcomes between the early CCY, delayed CCY, and no CCY groups of patients. 1827 choledocholithiasis patients who underwent therapeutic ERCP were selected from the nationwide population databases of two million random samples. These patients were further divided into early CCY, delayed CCY, and no CCY performed. In our analysis, 1440 (78.8%) of the 1827 patients did not undergo CCY within 60 days of therapeutic ERCP, and only 239 (13.1%) patients underwent CCY during their index admission. The proportion of laparoscopic CCY increased from 37.2% to 73.6% in the delayed CCY group. There were no significant differences (p = 0.934) between recurrent biliary event (RBE) rates with or without early CCY within 60 days of ERCP. RBE event-free survival rates were significantly different in the early CCY (85.04%), delayed CCY (89.54%), and no CCY (64.45%) groups within 360 days of ERCP. The method of delayed CCY can reduce subsequent RBEs and increase the proportion of laparoscopic CCY with similar medical expenses to early CCY in Taiwan’s general practice environment.

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Section: Discussionsupporting

confidence: 77%

Role of Cholecystectomy in Choledocholithiasis Patients Underwent Endoscopic Retrograde Cholangiopancreatography

Wang

Tsai

Yang

et al. 2019

Sci Rep

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“…Many studies demonstrate that healthcare behavior is also a research emphasis in addition to healthcare quality, and they unanimously state that system implementation will cause changes in healthcare behavior [7,[26][27][28]. These changes may also include adverse effects.…”

Section: Plos Onementioning

confidence: 99%

Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

et al. 2020

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Objectives Taiwan has implemented the Diagnosis Related Groups (DRGs) since 2010, and the quality of care under the DRG-Based Payment System is concerned. This study aimed to examine the characteristics, related factors, and time distribution of emergency department (ED) visits, readmission, and hospital transfers of inpatients under the DRG-Based Payment System for each Major Diagnostic Category (MDC). Methods We conducted a retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) from 2012 to 2013 in Taiwan. Multilevel logistic regression analysis was used to examine the factors related to ED visits, readmissions, and hospital transfers of patients under the DRG-Based Payment System. Results In this study, 103,779 inpatients were under the DRG-Based Payment System. Among these inpatients, 4.66% visited the ED within 14 days after their discharge. The factors associated with the increased risk of ED visits within 14 days included age, lower monthly salary, urbanization of residence area, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, Diseases and Disorders of the Kidney and Urinary Tract (MDC11) conferred the highest risk of ED visits within 14 days (OR = 4.95, 95% CI: 2.69–9.10). Of the inpatients, 6.97% were readmitted within 30 days. The factors associated with the increased risk of readmission included gender, age, lower monthly salary, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, the inpatients with Pregnancy, Childbirth and the Puerperium (MDC14) had the highest risk of readmission within 30 days (OR = 20.43, 95% CI: 13.32–31.34). Among the inpatients readmitted within 30 days, 75.05% of them were readmitted within 14 days. Only 0.16% of the inpatients were transferred to other hospitals. Conclusion The study shows a significant correlation between Major Diagnostic Categories in surgery and ED visits, readmission, and hospital transfers. The results suggested that the main reasons for the high risk may need further investigation for MDCs in ED visits, readmissions, and hospital transfers.

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“…DRGs bear inherent risks of potential harm to patients by quality of health services to reduce the cost of healthcare. Previous studies showed that implementing DRGs decreased the duration of stay and out-of-pocket costs [ 5 ] as well as significantly reducing examination fees relative to fee-for-service (FFS) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Laboratory tests are a large part of modern medicine. Nearly all inpatients, about half of patients in the emergency department, and nearly one-third of outpatients had laboratory results during their visit to the healthcare center [ 12 ], comprising a small portion (5–6%) of the total cost of healthcare [ 5 , 6 ]. Since poor laboratory results can significantly impact patients’ care, monitoring and improving the quality of laboratory tests is crucial [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesized that the introduction of the NDRG system could negatively affect the quality of laboratory tests because the NDRG is a modified DRG. Although there was a recent report regarding significantly reduced examination fees after the introduction of DRG [ 6 ], there have been no reports about the quality of laboratory tests after the introduction of DRGs or NDRGs. Thus, in this study, we aimed to evaluate the effects of NDRGs on the quality of laboratory tests by analyzing EQA results as a quality marker.…”

Section: Introductionmentioning

confidence: 99%

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The New Diagnosis-Related Group Reimbursement System and Laboratory Test Quality in Korea: Analysis of External Quality Assessment Results

et al. 2020

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Korea introduced a new diagnosis-related group (NDRG), which is a mixed-bundle reimbursement system. We evaluated the effects of NDRGs on laboratory test quality by analyzing data over three years (2016–2018) from the Korean Association of External Quality Assessment Service (KEQAS). A total of 42 NDRG-participating hospitals (CASE), 84 non-participating similar size-hospitals (CON-1), and 42 tertiary hospitals (CON-2) were included. We assumed the proportion of KEQAS results with a larger than 2 standard deviation index (SDI) to be a bad laboratory quality marker (BLQM). CASE BLQMs were lower than CON-1 BLQMs for more than 2 years in alkaline phosphatase (ALP), alanine aminotransferase (ALT), chloride, glucose, sodium, and total protein, and higher in creatinine. CASE BLQMs were higher than CON-2 BLQMs for more than 2 years in ALP, chloride, creatinine, glucose, lactate dehydrogenase (LDH), phosphorus, potassium, sodium, total calcium, total cholesterol, triglyceride, and uric acid. Mean SDIs for general chemistry tests were not significantly different depending on NDRG participation. However, the NDRG is currently a pilot program that compensates the amount of each institution’s reimbursement based on the fee-for-service system, and most participants were public hospitals. Thus, the effects of NDRGs on laboratory test quality should be re-evaluated after the NDRG program has stabilized and more private hospitals are participating.

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Effects of diagnosis-related group payment on health-care provider behaviors: A consecutive three-period study

Cited by 26 publications

References 17 publications

Role of Cholecystectomy in Choledocholithiasis Patients Underwent Endoscopic Retrograde Cholangiopancreatography

Role of Cholecystectomy in Choledocholithiasis Patients Underwent Endoscopic Retrograde Cholangiopancreatography

Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

The New Diagnosis-Related Group Reimbursement System and Laboratory Test Quality in Korea: Analysis of External Quality Assessment Results

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