Did case-based payment influence surgical readmission rates in France? A retrospective study

Vuagnat, Albert; Yilmaz, Engin; Roussot, Adrien; Rodwin, Victor G.; Gadreau, Maryse; Bernard, Alain; Creuzot‐Garcher, Catherine; Quantin, Catherine

doi:10.1136/bmjopen-2017-018164

Cited by 13 publications

(8 citation statements)

References 46 publications

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“…A previous study in France examined the risk of readmission within 30 days and the trends in patients from different MDCs before and after implementing a DRG-based payment system [ 45 ]. They found that as time progressed, ophthalmology gradually became the disease category with the highest risk of readmission within 30 days, while obstetric and gynecological diseases also had a higher risk of readmission within 30 days than other disease categories [ 45 ]. Our study also found that patients with Diseases and Disorders of the Skin, Subcutaneous Tissue, and Breast (MDC9) had the second-highest risk of readmission within 30 days.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Previous research suggests that their effects tend to be greatest during the initial implementation period and stabilize or dissipate over time. 4 Research has documented increased readmissions in Switzerland 44 and France, 10 suggesting that more research on the long-term association of DRGs with quality of care is warranted. Second, our data only included readmissions and deaths in public hospitals; readmissions to private hospitals and deaths outside public hospitals were not captured.…”

Section: Discussionmentioning

confidence: 99%

“…4 , 5 , 6 , 7 , 8 Reductions in length of stay have generally been observed after the introduction of DRGs, whereas evidence on volume of care and other quality indicators is mixed. 2 , 6 , 9 , 10 Some studies have attributed variations in the consequences of DRGs to health care system factors. Busse et al 2 suggested that DRGs were associated with an increase in volume of care when replacing a global budget system but with a decrease when replacing a fee-for-service system.…”

Section: Introductionmentioning

confidence: 99%

“…Busse et al 2 suggested that DRGs were associated with an increase in volume of care when replacing a global budget system but with a decrease when replacing a fee-for-service system. Vuagnat et al 10 documented increased readmission rates at private hospitals but not public hospitals after the implementation of DRGs. More robust estimations are needed worldwide to determine the circumstances in which DRG-based systems are likely to produce positive or negative outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Length of Stay, Care Volume, In-Hospital Mortality, and Emergency Readmission Rate Associated With Use of Diagnosis-Related Groups for Internal Resource Allocation in Public Hospitals in Hong Kong

Fung

Shum

et al. 2022

JAMA Netw Open

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IMPORTANCE Hong Kong's internal resource allocation system for public inpatient care changed from a global budget system to one based on diagnosis-related groups (DRGs) in 2009 and returned to a global budget system in 2012. Changes in patient and hospital outcomes associated with moving from a DRG-based system to a global budget system for inpatient care have rarely been evaluated. OBJECTIVETo examine associations between the introduction and discontinuation of DRGs and changes in length of stay, volume of care, in-hospital mortality rates, and emergency readmission rates in the inpatient population in acute care hospitals overall, stratified by age group, and across 5 medical conditions. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included data from patients aged 45 years or older who were hospitalized in public acute care settings in Hong Kong before the introduction (April 2006 to March 2009), during implementation (April 2009 to March 2012), and after discontinuation (April 2012 to November 2014) of the DRG scheme. Data analysis was conducted from January to June 2021. EXPOSURES Public hospitals transitioned from a global budget payment system to a DRG-based system in April 2009 and returned to a global budget system in April 2014. MAIN OUTCOMES AND MEASURES The main outcome was the association of use of DRGs with patient-level length of stay, in-hospital mortality rate, 1-month emergency readmission rate, and population-level number of admissions per month. An interrupted time series design was used to estimate changes in the level and slope of outcome variables after introduction and discontinuation of DRGs, accounting for pretrends. RESULTSThis study included 7 604 390 patient episodes. Overall, the mean (SD) age of patients was 68.97 (13.20) years, and 52.17% were male. The introduction of DRGs was associated with a 1.77% (95% CI, 1.23%-2.32%) decrease in the mean length of stay, a 2.90% (95% CI, 2.52%-3.28%) increase in the number of patients admitted, a 4.12% (95% CI, 1.89%-6.35%) reduction in in-hospital mortality, and a 2.37% (95% CI, 1.28%-3.46%) decrease in emergency readmissions. Discontinuation of the DRG scheme was associated with a 0.93% (95% CI, 0.42%-1.44%) increase in the mean length of stay and a 1.82% (95% CI, 1.47%-2.17%) reduction in the number of patients treated after adjusting for covariates; no statistically significant change was observed in in-hospital mortality (−0.14%; 95% CI, −2.29% to 2.01%) or emergency readmission rate (−0.29%; 95% CI, −1.30% to 0.71%). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, the introduction of DRGs was associated with shorter lengths of stay and increased hospital volume, and discontinuation was (continued) Key Points Question Were the introduction and discontinuation of diagnosis-related groups (DRGs) for resource allocation in Hong Kong public hospitals associated with patients' length of stay, hospitals' volume of care, inpatient mortality rates, and emergency readmission rates? Findings In this cross-sectional study of 7...

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“…These analysis results show that DRG standardized price systems are not immune to political pressure. Vuagnat et al ( 27 ) studied the impact of the implementation of a case-based payment system on postoperative readmission. The results showed that the rate of readmission in the private and public sectors increased relatively steadily and did not seem to be affected by the case-based payment system.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Obstetric Patient Flow and Horizontal Allocation of Medical Resources Based on Time Series Analysis

Wang

et al. 2021

Front. Public Health

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Objective: Given the ever-changing flow of obstetric patients in the hospital, how the government and hospital management plan and allocate medical resources has become an important problem that needs to be urgently solved. In this study a prediction method for calculating the monthly and daily flow of patients based on time series is proposed to provide decision support for government and hospital management.Methods: The historical patient flow data from the Department of Obstetrics and Gynecology of the First Hospital of Jilin University, China, from January 1, 2018, to February 29, 2020, were used as the training set. Seven models such as XGBoost, SVM, RF, and NNAR were used to predict the daily patient flow in the next 14 days. The HoltWinters model is then used to predict the monthly flow of patients over the next year.Results: The results of this analysis and prediction model showed that the obstetric inpatient flow was not a purely random process, and that patient flow was not only accompanied by the random patient flow but also showed a trend change and seasonal change rule. ACF,PACF,Ljung_box, and residual histogram were then used to verify the accuracy of the prediction model, and the results show that the Holtwiners model was optimal. R2, MAPE, and other indicators were used to measure the accuracy of the 14 day prediction model, and the results showed that HoltWinters and STL prediction models achieved high accuracy.Conclusion: In this paper, the time series model was used to analyze the trend and seasonal changes of obstetric patient flow and predict the patient flow in the next 14 days and 12 months. On this basis, combined with the trend and seasonal changes of obstetric patient flow, a more reasonable and fair horizontal allocation scheme of medical resources is proposed, combined with the prediction of patient flow.

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Did case-based payment influence surgical readmission rates in France? A retrospective study

Cited by 13 publications

References 46 publications

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

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

Evaluation of Length of Stay, Care Volume, In-Hospital Mortality, and Emergency Readmission Rate Associated With Use of Diagnosis-Related Groups for Internal Resource Allocation in Public Hospitals in Hong Kong

Prediction of Obstetric Patient Flow and Horizontal Allocation of Medical Resources Based on Time Series Analysis

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