The impact of disease-related group payment methods on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders in Xi'an and its improvement strategy_Chinese Journal of Ocular Fundus Diseases

Authors：

Guo Weiyan ^1,2,3 , Lin Xuemei ^1,3 , Liu Yan ^1,3 , Chang Qiaoqiao ^1,3 , Liu Pei ^1,3 , Liu Zhongzhong ^1,3 ,  Wu Songdi ^1,3

1. Department of Neuroophthalmology, The First Affiliated Hospital of Northwest University (Xi’an No.1 Hospital), Xi’an 710002, China;
2. Department of Pharmacy, The First Affiliated Hospital of Northwest University (Xi’an No.1 Hospital), Xi’an 710002, China;
3. Xi’an Key Laboratory of Innovation and Transformation of Neuroimmunological Diseases, Xi’an 710002, China;

Corresponding author：

Wu Songdi, Email: wusongdi@gmail.com

Keywords：

Diagnosis-related group; Payment method; Inpatient medical insurance patients; Neuromyelitis optica spectrum disorders

DOI：

10.3760/cma.j.cn511434-20240110-00018

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Objective To preliminary investigate the impact of the diagnosis-related groups (DRG) payment method reform on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders (NMOSD), and to propose potential improvement strategies. Methods A single-center, retrospective study. From October 1, 2020, to September 30, 2022, 44 hospitalized medical insurance patients with acute-phase NMOSD diagnosed and treated at the First Affiliated Hospital of Northwest University (Xi'an First Hospital) were included in the study. Among them, there were 11 males and 33 females, with an average age of (40.8±20.2) years. According to the implementation time of DRG payment, patients were divided into two groups: group A, which consists of cases one year before the implementation of DRG payment from October 1, 2020 to September 30, 2021, and group B, which consists of cases one year after the implementation of DRG payment from October 1, 2021 to September 30, 2022, with 20 and 24 cases, respectively. Detailed information such as hospitalization duration, treatment methods, and hospitalization costs of the two groups of patients was collected. Comparative analysis was conducted on hospitalization costs and treatment methods between the two groups. For intergroup comparison, t-test was used for normally distributed data, and Mann-Whitney U test was used for skewed distributed data. Results Among the 44 patients, 5 cases (5/24, 20.8%) received plasma exchange (PE) treatment, all of whom were in group B. The numbers of patients who received and did not receive intravenous immunoglobulin (IVIG) treatment were 9 and 11 in group A, respectively, and 7 and 12 in group B (except for 5 cases who received PE treatment), respectively. Compared with group A, there was no significant decrease in hospitalization duration (t=0.004) and total hospitalization costs (Z=0.036), as well as costs for western medicine (Z=0.036), examinations (Z=0.011), laboratory tests (Z=0.040), treatments (Z=0.017), and nursing (Z=3.131) in group B, and the differences were not statistically significant (P＞0.05). For patients receiving PE treatment, except for the cost of western medicine (Z=0.062, P=0.804), the other costs (Z=8.288, 5.013, 11.400, 10.925, 9.126) were significantly higher than those of patients not receiving PE treatment, and the hospitalization duration (t=20.474) was significantly prolonged, with statistically significant differences (P＜0.05). The total hospitalization costs of patients receiving IVIG treatment were significantly higher than those not receiving IVIG treatment in both group A and group B, with statistically significant differences (Z=7.690, 10.314; P＜0.05). There was no statistically significant difference in the comparison of total hospitalization costs between patients receiving IVIG treatment in group A and group B (Z=0.137, P＞0.05). Conclusions There is no significant decrease in various hospitalization costs of NMOSD medical insurance patients in Xi'an after the implementation of DRG payment, especially for patients receiving PE treatment. It is suggested to optimize the rate stratification of NMOSD patients when implementing DRG payment methods.

Citation： Guo Weiyan, Lin Xuemei, Liu Yan, Chang Qiaoqiao, Liu Pei, Liu Zhongzhong, Wu Songdi. The impact of disease-related group payment methods on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders in Xi'an and its improvement strategy. Chinese Journal of Ocular Fundus Diseases, 2024, 40(6): 449-453. doi: 10.3760/cma.j.cn511434-20240110-00018 Copy

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6.	Li R, Wang J, Li C, et al. Rescue immunoadsorption treatment for neuromyelitis optica spectrum disorder attacks unresponsive to intravenous methylprednisolone[J/OL]. J Neuroimmunol, 2021, 356: 577604[2021-07-15]. https://pubmed.ncbi.nlm.nih.gov/33992860/. DOI: 10.1016/j.jneuroim.2021.577604.
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9.	Wingerchuk DM, Lucchinetti CF. Neuromyelitis optica spectrum disorder[J]. N Engl J Med, 2022, 387(7): 631-339. DOI: 10.1056/NEJMra1904655.
10.	关茗元, 王婷, 段冉冉, 等. 5种单克隆抗体预防视神经脊髓炎谱系疾病复发的有效性网状meta分析及安全性评价[J]. 中国药房, 2023, 34(5): 607-612. DOI: 10.6039/j.issn.1001-0408.2023.05.18.Guan MY, Wang T, Duan RR, et al. Efficacy and safety of five monoclonal antibodies in preventing relapse of neuromyelitis optica spectrum disorders: network meta-analysis[J]. China Pharmacy, 2023, 34(5): 607-612. DOI: 10.6039/j.issn.1001-0408.2023.05.18.
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1. 曹勇军, 党超, 李洪超, 等. 诊断相关分组或诊断-治疗打包支付方式下急性脑梗死诊断与治疗中国专家建议[J]. 中国神经精神疾病杂志, 2023, 49(1): 1-10. DOI: 10.3969/j.issn.1002-0152.2023.01.001.Cao YJ, Dang C, Li HC, et al. Chinese experts consensus on diagnosis and treatment of ischemic stroke under diagnosis related groups (DRG) or diagnosis-intervention packet (DIP) payment system[J]. Chin J Nerv Ment Dis, 2023, 49(1): 1-10. DOI: 10.3969/j.issn.1002-0152.2023.01.001.
2. 陈凤磊, 梁冰, 钱静, 等. DRG付费改革对广西某三甲医院患者住院费用影响研究[J]. 中国医院, 2023, 27(1): 53-55. DOI: 10.19660/j.issn.1671-0592.2023.01.14.Chen FL, Liang B, Qian J, et al. Research on the changes in patients' hospitalization expenses after the DRG payment reform in a grade Ⅲ level A hospital in Guangxi[J]. Chinese Hospitals, 2023, 27(1): 53-55. DOI: 10.19660/j.issn.1671-0592.2023.01.14.
3. 黄德晖, 吴卫平, 胡学强. 中国视神经脊髓炎谱系疾病诊断与治疗指南(2021版)[J]. 中国神经免疫学和神经病学杂志, 2021, 28(6): 423-436. DOI: 10.3969/j.issn.1006-2963.2021.06.002.Huang DH, Wu WP, Hu XQ. Chinese guidelines for the diagnosis and treatment of neuromyelitis optica spectrum disorders (2021 edition)[J]. Chin J Neuro immunol & Neuro, 2021, 28(6): 423-436. DOI: 10.3969/j.issn.1006-2963.2021.06.002.
4. Tian DC, Li Z, Yuan M, et al. Incidence of neuromyelitis optica spectrum disorder (NMOSD) in China: a national population-based study[J/OL]. Lancet Reg Health West Pac, 2020, 2: 100021[2020-09-06]. https://pubmed.ncbi.nlm.nih.gov/34327375/. DOI: 10.1016/j.lanwpc.2020.100021.
5. Nishimura H, Enokida H, Sakamoto T, et al. Immunoadsorption plasmapheresis treatment for the recurrent exacerbation of neuromyelitis optica spectrum disorder with a fluctuating anti-aquaporin-4 antibody level[J]. J Artif Organs, 2018, 21(3): 378-382. DOI: 10.1007/s10047-018-1044-3.
6. Li R, Wang J, Li C, et al. Rescue immunoadsorption treatment for neuromyelitis optica spectrum disorder attacks unresponsive to intravenous methylprednisolone[J/OL]. J Neuroimmunol, 2021, 356: 577604[2021-07-15]. https://pubmed.ncbi.nlm.nih.gov/33992860/. DOI: 10.1016/j.jneuroim.2021.577604.
7. Exuzides A, Sheinson D, Sidiropoulos P, et al. The costs of care from a US claims database in patients with neuromyelitis optica spectrum disorder[J/OL]. J Neurol Sci, 2021, 427: 117553[2021-08-15]. https://pubmed.ncbi.nlm.nih.gov/34224957/. DOI: 10.1016/j.jns.2021.117553.
8. Demuth S, Guillaume M, Bourre B, et al. Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study[J]. J Neuroinflammation, 2022, 19(1): 62. DOI: 10.1186/s12974-022-02420-2.
9. Wingerchuk DM, Lucchinetti CF. Neuromyelitis optica spectrum disorder[J]. N Engl J Med, 2022, 387(7): 631-339. DOI: 10.1056/NEJMra1904655.
10. 关茗元, 王婷, 段冉冉, 等. 5种单克隆抗体预防视神经脊髓炎谱系疾病复发的有效性网状meta分析及安全性评价[J]. 中国药房, 2023, 34(5): 607-612. DOI: 10.6039/j.issn.1001-0408.2023.05.18.Guan MY, Wang T, Duan RR, et al. Efficacy and safety of five monoclonal antibodies in preventing relapse of neuromyelitis optica spectrum disorders: network meta-analysis[J]. China Pharmacy, 2023, 34(5): 607-612. DOI: 10.6039/j.issn.1001-0408.2023.05.18.
11. Boedecker SC, Luessi F, Engel S, et al. Immunoadsorption and plasma exchange-efficient treatment options for neurological autoimmune diseases[J]. J Clin Apher, 2022, 37(1): 70-81. DOI: 10.1002/jca.21953.

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The impact of disease-related group payment methods on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders in Xi'an and its improvement strategy

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