Interrupted time series study on the service efficiency and cost structure of DRG payments in the GE1 group

Xiaoyan Yu^1*Hong Zhang²Lili Shen²Juan Chen²Jian Shi²Jinhong Cai²Xinwei Chen²Chunli Huang²Huiling Wang²

• ¹Affiliated Hospital of Nantong University, Nantong, China
• ²海门人民医院, Affiliated Hospital of Nantong University, Nantong, China

[Abstract]: Objective: Analyzing the changes in service efficiency and medical cost structure of the GE1 group (including GE13 and GE15) in a tertiary comprehensive medical institution in Nantong, China, before and after the implementation of MDT (Multi-Disciplinary Team)-based DRG payment management. Methods: Data from Nantong medical insurance patients in the GE13 and GE15 groups from the sample hospital between 2022 and 2023 were collected. The Mann-Whitney U test was used to analyze changes in medical cost structure and service efficiency indicators, and an interrupted time series model was employed to examine the trends of these changes.Results: The median length of hospital stay for patients in the GE13 group decreased from 10 days to 7 days (P<0.01), and the average cost per hospitalization decreased by 4912.89 yuan (P<0.01).The median length of hospital stay for patients in the GE15 group decreased from 8 days to 6 days (P<0.01), and the average cost per hospitalization was reduced by 2156.01 yuan (P<0.01). The ITS analysis of post-intervention trends showed that the intervention measures for the GE13 group achieved significant results in terms of length of hospital stay, average cost per admission, and medication costs. However, some indicators, such as material costs, examination fees, and laboratory test costs, did not exhibit a significant downward trend (P>0.05). Conclusion: After implementing MDT-based DRG management, the operational efficiency of the GE13 and GE15 groups improved, physicians' diagnostic and treatment behaviors became more standardized, medical quality was enhanced, medical costs were controlled, patients' hospitalization burden was reduced, and the issue of hospital medical insurance settlement losses was reversed. It is recommended to continue implementing MDT management for DRG groups, continuously refine pathways, optimize structures, improve efficiency, and strengthen medical record supervision. This study was conducted in the context of China's DRG reform and directly demonstrates the effectiveness of the reform in controlling healthcare costs. It is important to note that cost control was not achieved by reducing medical services or shifting patients elsewhere, but rather by improving resource utilization efficiency while ensuring the quality of care.