Multidisciplinary DRG management for rational medication in obstetrics: a cost analysis in Zhejiang Province

Zhejiang Province introduced diagnosis-related group (DRG) payment reform in 2020, covering all hospitalizations to reduce costs and improve services. However, its emphasis on financial indicators and overlooks the evaluation of medical rationality, especially for pregnant women. To bridge this gap, this study developed an obstetric multidisciplinary team (MDT) model in which pharmacists are integrated into prenatal decision-making. This represents a transformation from reactive cost control to proactive medication optimization.

This study collected DRG data of obstetric patients from a hospital between 2020 and 2024. First, we descripted the overall DRG operational performance and identified OZ13 (Other Pregnancy-Related diseases, with General Complications and Comorbidities) as the target disease groups by the Boston Matrix analysis. Subsequently, we employed Spearman correlation and Kruskal-Wallis H tests to identify key cost drivers. Finally, we applied a generalized linear model with gamma distribution and log-link function to determine key factors influencing medical costs.

After the implementation of the multidisciplinary team management, the Time Consumption Index (TCI) decreased from 1.06 to 0.9 and the Cost Consumption Index (CCI) dropped from 1 to 0.91. Meanwhile, the Case Mix Index (CMI) increased to 0.51. The OZ13 group was selected for follow-up analysis using the Boston Matrix analysis because group exhibited decreased average hospitalization expenditure but an increased Cost Consumption Index. OZ13 group analysis revealed hospitalization costs strongly correlated with pharmaceutical costs (p = 0. 81, P < 0. 01), with significant expenditure differences between 2020 and 2024 (P < 0. 05). Furthermore, the generalized linear model identified several factors influencing hospitalization costs for OZ13 patients, including a history of recurrent miscarriage or IVF status, gestational weeks, parity, age, and length of hospital stay.

The research findings show that early pharmacist involvement in the multidisciplinary team management has positively impacted hospital functioning, including quality, efficiency, and costs. It identifies pharmaceutical costs as the main adjustable expenditure in OZ13 disease group and highlights the necessity of differentiated management for complex cases.