The Effect of Diagnosis-Related Group Payment System on Quality of Care in the Field of Obstetrics and Gynecology among Korean Tertiary Hospitals
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Purpose: To examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) underthe fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospitalcare. Materials and Methods: Using the 2012−2014 administrative database from National Health Insurance Service claim data, we reviewedmedical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and thenumber of simultaneous and emergency operations, from before to after introduction of the DRGs. Results: DRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p<0.001). Readmission rates decreased after introductionof DRGs (2.13% vs. 1.19% for C-secs, 4.51% vs. 3.05% for hysterectomies, 4.77% vs. 2.65% for adnexectomies, allp<0.001). Spillover rates did not change. Simultaneous surgeries, such as colpopexy and transobturator-tape procedures, duringhysterectomies decreased, while colporrhaphy during hysterectomies and adnexectomies or myomectomies during C-secs didnot change. The number of emergency operations for hysterectomies and adnexectomies decreased. Conclusion: Implementation of DRGs in the field of obstetrics and gynecology among Korean tertiary hospitals led to reductionsin the length of stay without increasing outpatient visits and readmission rates. The number of simultaneous surgeries requiringexpensive operative instruments and emergency operations decreased after introduction of the DRGs.
Abstract
Purpose: To examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) underthe fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospitalcare. Materials and Methods: Using the 2012−2014 administrative database from National Health Insurance Service claim data, we reviewedmedical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and thenumber of simultaneous and emergency operations, from before to after introduction of the DRGs. Results: DRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p<0.001). Readmission rates decreased after introductionof DRGs (2.13% vs. 1.19% for C-secs, 4.51% vs. 3.05% for hysterectomies, 4.77% vs. 2.65% for adnexectomies, allp<0.001). Spillover rates did not change. Simultaneous surgeries, such as colpopexy and transobturator-tape procedures, duringhysterectomies decreased, while colporrhaphy during hysterectomies and adnexectomies or myomectomies during C-secs didnot change. The number of emergency operations for hysterectomies and adnexectomies decreased. Conclusion: Implementation of DRGs in the field of obstetrics and gynecology among Korean tertiary hospitals led to reductionsin the length of stay without increasing outpatient visits and readmission rates. The number of simultaneous surgeries requiringexpensive operative instruments and emergency operations decreased after introduction of the DRGs.
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