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

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 Multi-Disciplinary Team (MDT)-based DRG payment management.

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 (ITS) model was employed to examine the trends of these changes.

The median length of hospital stay for patients in the GE13 group decreased from 10 to 7 days (P < 0.01), and the average cost per hospitalization decreased by 4,912.89 yuan (P < 0.01). The median length of hospital stay for patients in the GE15 group decreased from 8 to 6 days (P < 0.01), and the average cost per hospitalization was reduced by 2,156.01 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).

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. This research reinforces the credibility of the DRG reform policy and provides a basis for higher-level healthcare insurance authorities to adjust diagnosis-related group payment standards and coordinate supporting policies.