ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1617945
This article is part of the Research TopicChanging Healthcare through Innovation in Clinical Management and Healthcare Policy Strategies: Focus on Quality Improvement for the PatientView all articles
Evaluating medical service performance of hospitals in Sichuan Province, China: Exploratory factor analysis and hierarchical clustering analysis based on diagnosis-related groups
Provisionally accepted
- 1The First People's Hospital of Neijiang, Neijiang, China
- 2Chongqing Medical University, Chongqing, China
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Objective: This study aims to evaluate hospital medical service performance in Sichuan Province, China.Methods: A total of 306 secondary and tertiary general hospitals were included in the analysis. A comprehensive evaluation model was developed using exploratory factor analysis (EFA) based on diagnosis-related groups (DGRS) indicators to assess medical service performance. Indicators were determined within the Donabedian structure-process-outcome (SPO) framework. Hierarchical clustering analysis (HCA) was applied to categorize hospitals into performance clusters, and the Kruskal-Wallis H test was used to compare disparities in performance characteristics across clusters.The comprehensive evaluation revealed that all top 10 hospitals were tertiary general hospitals (TGHs), with 40.00% located in the Chengdu region. Conversely, the bottom 10 hospitals were exclusively secondary general hospitals (SGHs), predominantly concentrated in northeastern Sichuan. TGHs were classified into three clusters: "Excellent" (30.83%), "Middle" (57.14%), and "Inferior" (12.03%), while SGHs were categorized as "Excellent" (26.01%), "Middle" (69.94%), and "Inferior" (4.05%). For TGHs, the "Excellent" cluster displayed significantly higher performance in case-mix index (CMI), number of DRGS (ND), total weight (TW), and time efficiency index (TEI) compared to the "Middle" and "Inferior" clusters, but performed worst in cost efficiency index (CEI) and mortality of middle and low-risk group cases (MMLRG). For SGHs, "Excellent" cluster hospitals significantly outperformed others in ND and TW, while the "Inferior" cluster performed best in CMI but alarmingly worst in MMLRG.Conclusions: Significant regional and hierarchical disparities in medical service performance were observed across Sichuan Province, with Chengdu region demonstrating optimal performance. For TGHs,
Keywords: DRGs, exploratory factor analysis, Hierarchical clustering analysis, Donabedian, Hospital, performance evaluation
Received: 25 Apr 2025; Accepted: 11 Jul 2025.
Copyright: © 2025 Liu, Cao, Ge and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xuedong Liu, The First People's Hospital of Neijiang, Neijiang, China
Ou Jiang, The First People's Hospital of Neijiang, Neijiang, China
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