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Associations of Chinese diagnosis-related group system with low-value coronary revascularisation: an interrupted time
Kun Zou1,2,3, Wenting Su4, Lingli Zhang1,2,3,5
1Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Sichuan, People's Republic of China.
Insights
The Chinese diagnosis-related group (C-DRG) payment system successfully reduced low-value coronary revascularisation in coronary heart disease patients. This policy also showed an increase in high-value procedures, supporting its effectiveness in improving care quality.
Area of Science:
- Health economics
- Cardiovascular medicine
- Health policy
Background:
- Coronary heart disease (CHD) management involves complex interventions, including coronary revascularisation.
- The implementation of payment systems like the Chinese diagnosis-related group (C-DRG) aims to optimize healthcare resource allocation and improve service value.
- Assessing the impact of C-DRG on the utilization of both low-value and high-value coronary revascularisation is crucial for understanding its effectiveness in CHD care.
Purpose of the Study:
- To evaluate the effect of the C-DRG payment system on low-value coronary revascularisation services for CHD inpatients.
- To determine if the C-DRG policy influences the utilization of high-value coronary revascularisation services.
- To provide evidence for policymakers regarding the impact of C-DRG on the quality and efficiency of CHD interventions.
Main Methods:
- Retrospective observational study utilizing health insurance claims data from 22 public hospitals in Sanming, China.
- Inclusion of all CHD inpatients from January 2017 to December 2020, with C-DRG implementation on January 1, 2018.
- Interrupted time series analysis comparing rates of low-value (ischaemic heart disease without acute conditions) and high-value (acute coronary syndrome) coronary revascularisation before and after C-DRG implementation.
Main Results:
- The C-DRG policy was associated with an immediate statistically significant decrease of -9.78% in low-value coronary revascularisation rates.
- A sustained quarterly decrease of -0.59% in low-value coronary revascularisation was observed post-C-DRG implementation.
- Quarterly rates of high-value coronary revascularisation increased by 1.27% after C-DRG implementation, indicating a potential shift towards more beneficial procedures.
Conclusions:
- The C-DRG payment system demonstrated short-term success in reducing the utilization of low-value coronary revascularisation among CHD patients.
- No evidence suggests that the C-DRG policy decreased the provision of high-value coronary revascularisation services.
- These findings support the use of C-DRG policies to reduce low-value care and potentially enhance high-value care in China and similar healthcare systems.
Objectives:
This study aimed to investigate whether the Chinese diagnosis-related group (C-DRG) payment system would reduce low-value coronary revascularisation services among coronary heart disease (CHD) inpatients without affecting high-value coronary revascularisation services.
Design:
Retrospective observational study.
Setting:
Routinely collected claims data from a health insurance database including all inpatients in 22 public hospitals in Sanming, Southern China.
Participants:
All patients with CHD are admitted to public hospitals from 1 January 2017 through 31 December 2020.
Intervention/Exposure:
The implementation of the C-DRG-based payment system on 1 January 2018.
Main Outcome Measures:
Using a health insurance database, we identified two cohorts: beneficiaries for whom the value of coronary revascularisation is lower (those with ischaemic heart disease without acute myocardial infarction, unstable angina and congestive heart failure during hospitalisation) and beneficiaries for whom its value is higher (those with acute coronary syndrome). Then, the rates of low-value or high-value coronary revascularisation were compared before and after the implementation of C-DRG policy, including the use of an interrupted time series analysis.
Results:
An interrupted time series analysis demonstrated that the C-DRG policy was associated with a statistically significant immediate decrease in the rate of low-value coronary revascularisation of -9.78% (95% CI: -11.08% to -8.48%). Further, after introducing C-DRG, the rate of low-value coronary revascularisation decreased by -0.59% (95% CI: -0.88% to -0.30%) every quarter compared with before C-DRG. In addition, after C-DRG, the rate of high-value coronary revascularisation increased by 1.27% (95% CI: 0.14% to 2.41%) every quarter compared with before C-DRG.
Conclusions:
This study suggested that C-DRG policy achieved at least short-term success in reducing use of low-value coronary revascularisation without evidence of decreasing high-value coronary revascularisation services. These results can support policymakers in reducing low-value care in China and other countries that use similar systems.
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