Improved management of hospital-acquired infections with DRG-based payment system: an interrupted time‑series...

While diagnosis-related group (DRG) payment system has been shown to improve healthcare quality and reduce costs in high-income countries, its effectiveness in developing countries, particularly in terms of hospital-acquired infection (HAI) management, remains unclear.

HAI surveillance data were collected from nine public hospitals in Zhejiang province, China, that implemented the DRG system in 2020. Changes in HAI incidence rates following DRG adoption were assessed using interrupted time-series analysis with a generalized additive model, covering the period from January 2016 to September 2023.

The HAI incidence rate demonstrated a general downward trend both before and after the DRG system's implementation. While no immediate change in the HAI rate was observed (-0.0124%; 95% CI: -0.1375%, 0.1127%) in the month immediately following DRG implementation (January 2020) when compared with December 2019, a significant monthly decline of 0.0072% (95% CI: -0.0124%, -0.0020%) was detected from January 2020 to September 2023, following the system's implementation. Additionally, a significant reduction in hospital stays prior to acquiring infection was noted post-implementation of the DRG system. The rising trend in the proportion of female patients, from 31.52% in 2016 to 40.00% in 2019, was eliminated after DRG adoption, with the proportion stabilizing thereafter. The age distribution, infection sites, and pathogen profiles remained largely stable throughout the study period.

These findings suggest that the implementation of the DRG system may contribute to improving HAI management, with notable reductions in the HAI incidence rate over time. Our study serves as a reference for other developing countries facing similar healthcare challenges, and provides valuable insights for improving healthcare quality and enhancing patient safety.