Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China.

OBJECTIVES: This study measures the differences in inpatient performance after a points-counting payment policy based on diagnosis-related group (DRG) was implemented. The point value is dynamic; its change depends on the annual DRGs' cost settlements and points of the current year, which are calculated at the beginning of the following year. DESIGN: A longitudinal study using a robust multiple interrupted time series model to evaluate service performance following policy implementation. SETTING: Twenty-two public general hospitals (8 tertiary institutions and 14 secondary institutions) in Wenzhou, China. INTERVENTION: The intervention was implemented in January 2020. OUTCOME MEASURES: The indicators were case mix index (CMI), cost per hospitalisation (CPH), average length of stay (ALOS), cost efficiency index (CEI) and time efficiency index (TEI). The study employed the means of these indicators. RESULTS: The impact of COVID-19, which reached Zhejiang Province at the end of January 2020, was temporary given rapid containment following strict control measures. After the intervention, except for the ALOS mean, the change-points for the other outcomes (p<0.05) in tertiary and secondary institutions were inconsistent. The CMI mean turned to uptrend in tertiary (p<0.01) and secondary (p<0.0001) institutions compared with before. Although the slope of the CPH mean did not change (p>0.05), the uptrend of the CEI mean in tertiary institutions alleviated (p<0.05) and further increased (p<0.05) in secondary institutions. The slopes of the ALOS and TEI mean in secondary institutions changed (p<0.05), but not in tertiary institutions (p>0.05). CONCLUSIONS: This study showed a positive effect of the DRG policy in Wenzhou, even during COVID-19. The policy can motivate public general hospitals to improve their comprehensive capacity and mitigate discrepancies in treatment expenses efficiency for similar diseases. Policymakers are interested in whether the reform successfully motivates hospitals to strengthen their internal impetus and improve their performance, and this is supported by this study.

An enhanced grey wolf optimizer boosted machine learning prediction model for patient-flow prediction.

Large and medium-sized general hospitals have adopted artificial intelligence big data systems to optimize the management of medical resources to improve the quality of hospital outpatient services and decrease patient wait times in recent years as a result of the development of medical information technology and the rise of big medical data. However, owing to the impact of several elements, including the physical environment, patient, and physician behaviours, the real optimum treatment effect does not meet expectations. In order to promote orderly patient access, this work provides a patient-flow prediction model that takes into account shifting dynamics and objective rules of patient-flow to handle this issue and forecast patients' medical requirements. First, we propose a high-performance optimization method (SRXGWO) and integrate the Sobol sequence, Cauchy random replacement strategy, and directional mutation mechanism into the grey wolf optimization (GWO) algorithm. The patient-flow prediction model (SRXGWO-SVR) is then proposed using SRXGWO to optimize the parameters of support vector regression (SVR). Twelve high-performance algorithms are examined in the benchmark function experiments' ablation and peer algorithm comparison tests, which are intended to validate SRXGWO's optimization performance. In order to forecast independently in the patient-flow prediction trials, the data set is split into training and test sets. The findings demonstrated that SRXGWO-SVR outperformed the other seven peer models in terms of prediction accuracy and error. As a result, SRXGWO-SVR is anticipated to be a reliable and efficient patient-flow forecast system that may help hospitals manage medical resources as effectively as possible.