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. 2020 Dec 9;15(12):e0243373.
doi: 10.1371/journal.pone.0243373. eCollection 2020.

Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

Pei-Fang Huang  1   2 , Pei-Tseng Kung  3   4 , Wen-Yu Chou  1 , Wen-Chen Tsai  1
Affiliations

Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

Pei-Fang Huang et al. PLoS One. .

Abstract

Objectives: Taiwan has implemented the Diagnosis Related Groups (DRGs) since 2010, and the quality of care under the DRG-Based Payment System is concerned. This study aimed to examine the characteristics, related factors, and time distribution of emergency department (ED) visits, readmission, and hospital transfers of inpatients under the DRG-Based Payment System for each Major Diagnostic Category (MDC).

Methods: We conducted a retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) from 2012 to 2013 in Taiwan. Multilevel logistic regression analysis was used to examine the factors related to ED visits, readmissions, and hospital transfers of patients under the DRG-Based Payment System.

Results: In this study, 103,779 inpatients were under the DRG-Based Payment System. Among these inpatients, 4.66% visited the ED within 14 days after their discharge. The factors associated with the increased risk of ED visits within 14 days included age, lower monthly salary, urbanization of residence area, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, Diseases and Disorders of the Kidney and Urinary Tract (MDC11) conferred the highest risk of ED visits within 14 days (OR = 4.95, 95% CI: 2.69-9.10). Of the inpatients, 6.97% were readmitted within 30 days. The factors associated with the increased risk of readmission included gender, age, lower monthly salary, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, the inpatients with Pregnancy, Childbirth and the Puerperium (MDC14) had the highest risk of readmission within 30 days (OR = 20.43, 95% CI: 13.32-31.34). Among the inpatients readmitted within 30 days, 75.05% of them were readmitted within 14 days. Only 0.16% of the inpatients were transferred to other hospitals.

Conclusion: The study shows a significant correlation between Major Diagnostic Categories in surgery and ED visits, readmission, and hospital transfers. The results suggested that the main reasons for the high risk may need further investigation for MDCs in ED visits, readmissions, and hospital transfers.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The time distribution of emergency department visits within 14 days after discharge.
Fig 2
Fig 2. The time distribution of readmission within 30 days after discharge.
See this image and copyright information in PMC

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References

    1. Stern RS, Epstein AM. Institutional responses to prospective payment based on diagnosis-related groups. Implications for cost, quality, and access. The New England journal of medicine. 1985;312(10):621–7. Epub 1985/03/07. 10.1056/NEJM198503073121005 . - DOI - PubMed
    1. Moreno-Serra R, Wagstaff A. System-wide impacts of hospital payment reforms: evidence from Central and Eastern Europe and Central Asia. Journal of health economics. 2010;29(4):585–602. Epub 2010/06/23. 10.1016/j.jhealeco.2010.05.007 . - DOI - PubMed
    1. Schargus M, Gass P, Neubauer A, Kotas M. Development of the German diagnosis-related groups (G-DRG) for ophthalmology from 2004 to 2012. Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 2014;111(4):354–64. Epub 2013/06/20. 10.1007/s00347-013-2886-y . - DOI - PubMed
    1. Jang SI, Nam CM, Lee SG, Kim TH, Park S, Park EC. Impact of payment system change from per-case to per-diem on high severity patient's length of stay. Medicine. 2016;95(37). 10.1097/MD.0000000000004839 - DOI - PMC - PubMed
    1. Wang K, Li P, Chen L, Kato K, Kobayashi M, Yamauchi K. Impact of the Japanese diagnosis procedure combination-based payment system in Japan. Journal of medical systems. 2010;34(1):95–100. Epub 2010/03/03. 10.1007/s10916-008-9220-2 . - DOI - PubMed

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