Comparison of diagnosis-related groups (DRG)-based hospital payment system design and implementation strategies in different countries: The case of ischemic stroke.

Diagnosis-related groups (DRG) based hospital payment systems are gradually becoming the main mechanism for reimbursement of acute inpatient care. We reviewed the existing literature to ascertain the global use of DRG-based hospital payment systems, compared the similarities and differences of original DRG versions in ten countries, and used ischemic stroke as an example to ascertain the design and implementation strategies for various DRG systems. The current challenges with and direction for the development of DRG-based hospital payment systems are also analyzed. We found that the DRG systems vary greatly in countries in terms of their purpose, grouping, coding, and payment mechanisms although based on the same classification concept and that they have tended to develop differently in countries with different income classifications. In high-income countries, DRG-based hospital payment systems have gradually begun to weaken as a mainstream payment method, while in middle-income countries DRG-based hospital payment systems have attracted increasing attention and increased use. The example of ischemic stroke provides suggestions for mutual promotion of DRG-based hospital payment systems and disease management. How to determine the level of DRG payment incentives and improve system flexibility, balance payment goals and disease management goals, and integrate development with other payment methods are areas for future research on DRG-based hospital payment systems.

Facing frailty: Are you ready?

By far, there is no general consensus concerning the definition of frailty even though it may be a global public health concern with aging of the population. It is regarded as a pathophysiological state before development of a severe illness that is associated with many adverse outcomes. Although previous studies attempted to verify its clinical value to prevent the development of serious illness, robust evidence is lacking. Based on previous studies of frailty, the current study analyzed the problems with existing investigations of frailty and it puts forward future strategies to improve those investigations. Finalizing the definition of frailty is the first step. Next, development of objective tools to identify/measure frailty based on the newest biological and computerized technologies is indispensable. Finally, well-designed clinical trials also need to be conducted to yield compelling evidence regarding the clinical value of medical interventions in frailty.

Trends in managing COVID-19 from an emerging infectious disease to a common respiratory infectious disease: What are the subsequent impacts on and new challenges for healthcare systems?

Targeting the 9 countries with the highest cumulative number of newly confirmed cases in the past year, we analyzed the case fatality ratio (CFR) among newly confirmed cases and the vaccination rate (two or more doses of vaccine per 100 people) in the United States of America (USA), India, France, Germany, Brazil, the Republic of Korea, Japan, Italy, and the United Kingdom (UK) for the period of 2020-2022. Data reveal a decrease in the CFR among newly confirmed cases since the beginning of 2022, when transmission of the Omicron variant predominates, and an increase in vaccination rates. The Republic of Korea had the lowest CFR among newly confirmed cases (0.093%) in 2022 and the highest vaccination rate (86.27%). Japan had the second highest vaccination rate (83.12%) and a decrease in the CFR among newly confirmed cases of 1.478% in 2020, 1.000% in 2021, and 0.148% in 2022; while the average estimated fatality ratio for seasonal influenza from 2015-2020 was 0.020%. Currently, most countries are now easing COVID-19-related restrictions and are exploring a shift in management of COVID-19 from an emerging infectious disease to a common respiratory infectious disease that can be treated as the equivalent of seasonal or regional influenza. However, compared to influenza, infection with the Omicron variant still has a higher fatality ratio, is more transmissible, and the size of future outbreaks cannot be accurately predicted due to the uncertainty of viral mutation. More importantly, as countries shift their response strategies to COVID-19, there is an urgent need at this time to clarify what the subsequent impacts on healthcare systems and new challenges will be, including the clinical response, the dissemination of scientific information, vaccination campaigns, the creation of future surveillance and response systems, the cost of treatments and vaccinations, and the flexible use of big data in healthcare systems.

An average of nearly 200,000 new infections per day over a six-week period: What is the impact of such a severe COVID-19 pandemic on the healthcare system in Japan?

During a six-week period from July 20 to August 31, 2022, Japan experienced its highest level of COVID-19 infection ever, with an average of nearly 200,000 new infections per day nationwide. Cases requiring inpatient care peaked at 1,993,062. Twenty-seven prefectures (out of 47 prefectures) had an average hospital bed occupancy of 50% or higher, and bed occupancy in Kanagawa in particular reached 98% in mid-August. In Tokyo, bed occupancy by patients with severe COVID-19 reached 57% and peaked at 64% in mid-August. Although the number of new infections per day has decreased since September, hospital bed occupancy, the number of severe cases, and deaths remain high nationwide. Efforts including vaccination campaigns, domestic surveillance, and routine infection control measures based on the varied knowledge that the Japanese public already has should be thoroughly implemented to reduce the number of the infected in order to avoid an increase the number of serious cases and deaths.

The strategy behind Japan's response to COVID-19 from 2020-2021 and future challenges posed by the uncertainty of the Omicron variant in 2022.

Japan has experienced five waves of the COVID-19 pandemic so far. Four states of emergency were declared, and the Tokyo 2020 Olympic (July 23-August 8, 2021) and Paralympic Games (August 24-September 5, 2021) were held during the fifth wave of the pandemic. Although a record 5,773 new cases were reported in Tokyo on August 13, the number abruptly decreased afterwards, and only 9 new cases were confirmed in Tokyo on November 1, 2021. The high vaccination rates (79.2% of the total population has received the first dose and 77.8% has received the second dose as of December 24, 2021) and behavioral changes (such as mask wearing rate in public places remains close to 100%) are considered to be important factors in curbing the spread of the virus. However, the new Omicron variant poses future challenges due to its uncertainty. A cumulative total of 231 cases of the Omicron variant were reported in Japan between November 30 and December 25, 2021. Preliminary data indicated that the Omicron variant could be more contagious but less deadly than the Delta variant. Since mankind may be forced to coexist with COVID-19, efforts such as vaccination campaigns will need to continue and behavioral changes will become increasingly important as the "new normal" to reduce population density and contact with people. This is evinced at least in Japan's successful practices in fighting the past five waves of the pandemic.

Scientific solidarity in the face of the COVID-19 pandemic: researchers, publishers, and medical associations.

In the face of COVID-19, the scientific community has rapidly come together to address this outbreak in an open and collaborative manner to support the global response to this outbreak by rapidly sharing and highlighting research data and relevant findings. COVID-19 research is being published at a furious pace. Over 6,000 articles have been published as of 20 April 2020, and at least 15 online resource centers/websites for COVID-19 have been created by publishers to enable fast and free access to the latest research, evidence, and data available. Moreover, many evidence-based guidelines for COVID-19 have been issued based on academic articles and summaries of the experiences of frontline medical personnel. Various academic medical associations are also actively sharing information and providing technical support. As an example, 93 guides/proposals/responses to COVID-19 have been issued so far by 50 medical associations in Japan. However, few publications and national situation reports have provided information on the number of infected healthcare workers (HCWs). More publications and national situation reports are urgently needed to provide scientific information to devise specific infection prevention and control measures in order to protect HCWs from infection.

COVID-19: Real-time dissemination of scientific information to fight a public health emergency of international concern.

Rapidly sharing scientific information is an effective way to reduce public panic about COVID-19, and doing so is the key to providing real-time guidance to epidemiologists working to contain the outbreak, clinicians managing patients, and modelers helping to understand future developments and the possible effectiveness of various interventions. This issue has rapidly reviewed and published articles describing COVID-19, including the drug treatment options for SARS-CoV-2, its clinical characteristics, and therapies involving a combination of Chinese and Western medicine, the efficacy of chloroquine phosphate in the treatment of COVID-19 associated pneumonia according to clinical studies, and reflections on the system of reserve medical supplies for public health emergencies. As an academic journal, we will continue to quickly and transparently share data with frontline healthcare workers who need to know the epidemiological and clinical features of COVID-19.