Construction of Hospital DRG Refinement Performance Evaluation based on Delphi Method and Analytic Hierarchy Process (AHP)
Authors: Cai Mingchun , Yan Zhengbo , Wang Xiaoli , Mao Bing , pu chuan 
Published: August 2023

Abstract
Objective: This study aimed to develop a comprehensive performance evaluation index system for a district-level public hospital in Chongqing, China, based on Diagnosis Related Groups (DRG). The goal was to provide an objective benchmark for performance assessment in county-level hospitals. To achieve this, a rigorous approach was undertaken to identify and assess the indicators.The research considered relevant policies on public hospital performance evaluation and conducted a thorough analysis of existing literature. The Delphi method was utilized to gather expert opinions and reach a consensus on the most relevant assessment indicators. Subsequently, the Analytic Hierarchy Process (AHP) was employed to establish a priority graph and assign weights to each indicator based on their relative importance.The Total Technical Loss (TTL) values were then calculated and normalized to derive weight coefficients for each indicator. These coefficients were used to verify the indicators through empirical testing. This validation process ensured the reliability and validity of the refined performance evaluation index system.By employing these methods, the study successfully constructed a robust and objective evaluation system tailored to the specific needs of district-level public hospitals. This system can now serve as a valuable reference for performance assessment in county-level hospitals, facilitating the improvement of healthcare services and overall performance in the region.
Results: The refined hospital performance evaluation index system consisted of three primary indicators and eighteen secondary indicators. Among the secondary indicators, several were of particular significance, as indicated by their relatively high weights: Case Mix Index (CMI) with a weight of 0.108, Cost Consumption Index with a weight of 0.102, Low-Risk Group Mortality Rate with a weight of 0.096, the proportion of patients with three or four-level surgeries at discharge with a weight of 0.086, and the proportion of medical service revenue (excluding drugs and consumables) to medical income with a weight of 0.086.In 2020, remarkable improvements were observed in some key indicators compared to the previous year. The low-risk group mortality rate exhibited an impressive decline, reducing from 0.02% in 2019 to an outstanding 0% in 2020. Moreover, there was a significant increase of nearly 10% in the proportion of patients with three or four-level surgeries at discharge, indicating a positive trend in the complexity and quality of surgical procedures provided by the hospital.Furthermore, the Case Mix Index (CMI) demonstrated substantial growth of approximately 13% compared to the previous year. This increase signifies a higher level of complexity and severity in the patient cases treated by the hospital, reflecting its enhanced capacity to handle more challenging medical conditions.Additionally, the Cost Consumption Index, with a weight of 0.102, was closely monitored, and although not explicitly mentioned for 2020, it is implied that efforts were made to manage and optimize cost consumption in the hospital's operations.These positive trends and achievements indicate that the implementation of the refined performance evaluation index system has been effective in driving improvements in the hospital's overall performance. By focusing on these crucial indicators, the hospital can continue to enhance its services, increase efficiency, and provide better healthcare outcomes for patients.
Conclusion: This study successfully developed a scientifically reasonable and comprehensive performance evaluation index system tailored to a district-level public hospital in Chongqing. Through rigorous empirical research, the index system was shown to be highly effective in objectively assessing the performance of inpatient medical care within the studied area.The findings from the empirical research demonstrated that the index system provided positive and valuable guidance for the assessment of district-level hospitals. By utilizing this refined evaluation framework, hospital administrators and healthcare policymakers can gain valuable insights into the hospital's strengths and areas for improvement. This, in turn, enables them to make informed decisions and implement targeted strategies to enhance the hospital's overall performance and the quality of patient care.With its objective and well-structured approach, the index system not only serves as a reliable performance measurement tool but also as a valuable reference for assessing the efficiency and effectiveness of other district-level hospitals. This contributes to the continuous advancement of healthcare services and standards in the region.Overall, the study's findings highlight the importance of utilizing a robust evaluation index system for healthcare institutions, and its successful application in a district-level public hospital in Chongqing sets a precedent for improving medical care and management practices in similar settings.