2.1 Obstetric disease group status
From January 1, 2020, to December 31, 2022, a specialized hospital’s obstetric department had a total of 67,281 discharged cases, involving 103 DRG disease groups. Excluding the disease groups with fewer than 30 cases, a total of 63586 cases were included in 32 DRG disease groups. Specific information is shown in Table 1 and the obstetric treatment groups are shown in Table 2. Subsequently, a Boston Matrix diagram was created with the weight RW of the disease as the abscissa (1 as the origin) and the average balance/overspend as the vertical coordinate (Figure 1).
Table 1. The specific situation of the Department of Obstetrics
DRG groups
|
Case
|
Medical cost per time (yuan)
|
Case Balance/Overspend (yuan)
|
RW
|
OB13
|
18244
|
9502.47
|
244.66
|
1.16
|
OC13
|
13211
|
5590.55
|
240.88
|
0.68
|
OC19
|
12131
|
7913.52
|
-618.21
|
0.97
|
OZ13
|
7633
|
2562.20
|
-146.10
|
0.31
|
OZ15
|
2216
|
1868.53
|
274.22
|
0.23
|
OB11
|
1936
|
13596.78
|
-1166.66
|
1.66
|
OB15
|
1887
|
8209.37
|
976.00
|
1.00
|
OC11
|
910
|
7197.28
|
-143.41
|
0.88
|
OR13
|
906
|
4921.01
|
255.69
|
0.60
|
OF13
|
760
|
4823.87
|
-535.45
|
0.59
|
OD23
|
668
|
6546.52
|
-926.14
|
0.80
|
OC15
|
402
|
5624.78
|
0.85
|
0.69
|
OZ11
|
376
|
3265.68
|
205.03
|
0.40
|
OF15
|
333
|
4258.10
|
-692.60
|
0.52
|
OR19
|
286
|
7248.92
|
-453.75
|
0.88
|
OS23
|
274
|
3590.18
|
-281.93
|
0.44
|
OS13
|
204
|
2706.63
|
17.31
|
0.33
|
OR15
|
181
|
4433.87
|
415.95
|
0.54
|
OF11
|
152
|
7847.87
|
-929.61
|
0.96
|
OJ13
|
132
|
5234.99
|
-1064.86
|
0.64
|
OF23
|
96
|
4056.61
|
-1082.02
|
0.49
|
OR11
|
94
|
5576.32
|
1135.25
|
0.68
|
OS15
|
94
|
1950.94
|
132.45
|
0.24
|
OD25
|
79
|
3791.47
|
169.32
|
0.46
|
OS25
|
60
|
3309.44
|
-701.01
|
0.40
|
OD13
|
53
|
9328.25
|
-1443.79
|
1.14
|
OJ15
|
41
|
3038.78
|
-160.47
|
0.37
|
OF21
|
39
|
5093.71
|
-1075.03
|
0.62
|
OD21
|
38
|
10591.85
|
-3437.75
|
1.29
|
OF25
|
36
|
2809.49
|
-392.01
|
0.34
|
OS11
|
35
|
4031.61
|
-284.97
|
0.49
|
OS21
|
30
|
4905.81
|
-1084.50
|
0.60
|
Total
|
63537
|
6959.49
|
-40.79
|
|
Table 2. Obstetric admission group from 2020 to 2022
DRG groups
|
2020
|
2021
|
2022
|
Case
|
Medical cost per time (yuan)
|
Case Balance/Overspend (yuan)
|
Case
|
Medical cost per time (yuan)
|
Case Balance/Overspend (yuan)
|
Case
|
Medical cost per time (yuan)
|
Case Balance/Overspend (yuan)
|
OC13
|
7750
|
6491.91
|
-624.30
|
2960
|
4606.66
|
1346.63
|
2501
|
3961.92
|
1613.19
|
OB13
|
5435
|
9525.56
|
874.49
|
5988
|
9828.82
|
-209.00
|
6821
|
9197.57
|
141.05
|
OZ13
|
1550
|
2763.26
|
-117.16
|
2460
|
2629.07
|
-163.00
|
3623
|
2430.77
|
-147.00
|
OB15
|
863
|
8219.21
|
1606.21
|
624
|
8365.93
|
419.29
|
400
|
7943.90
|
484.82
|
OZ15
|
698
|
2023.94
|
405.46
|
800
|
1827.70
|
321.95
|
718
|
1762.94
|
93.46
|
OR13
|
632
|
5350.89
|
-194.79
|
176
|
3932.20
|
1356.49
|
98
|
3924.56
|
1183.90
|
OC11
|
542
|
7939.92
|
-852.11
|
179
|
6540.71
|
706.13
|
189
|
5689.42
|
1084.37
|
OB11
|
528
|
14526.61
|
-1207.46
|
599
|
14020.41
|
-1740.82
|
809
|
12676.25
|
-714.92
|
OC15
|
263
|
6604.41
|
-979.52
|
36
|
4245.33
|
1654.42
|
103
|
3605.54
|
1926.16
|
OF13
|
205
|
5832.88
|
-1271.19
|
250
|
4946.32
|
-664.47
|
305
|
4045.31
|
64.80
|
OD23
|
202
|
6800.08
|
-1332.84
|
224
|
6975.53
|
-653.99
|
242
|
5937.77
|
-838.58
|
OS23
|
175
|
3465.99
|
-158.25
|
33
|
3844.83
|
-309.82
|
66
|
3792.14
|
-595.91
|
OF15
|
133
|
4995.48
|
-1247.79
|
93
|
4272.57
|
-739.10
|
107
|
3328.97
|
37.92
|
OR15
|
126
|
5010.43
|
-182.94
|
17
|
3108.13
|
1551.28
|
38
|
3115.18
|
1893.82
|
OZ11
|
91
|
3655.51
|
80.91
|
121
|
3359.40
|
262.99
|
164
|
2980.22
|
231.13
|
OR11
|
74
|
5698.28
|
1258.06
|
9
|
4770.76
|
1196.21
|
11
|
5414.98
|
259.20
|
OF11
|
44
|
9401.40
|
-1889.00
|
50
|
8482.98
|
-990.83
|
58
|
6121.81
|
-149.01
|
OS25
|
43
|
3347.63
|
-642.52
|
5
|
2182.30
|
173.30
|
12
|
3642.24
|
-1274.88
|
OS13
|
33
|
2994.47
|
-8.88
|
70
|
2542.82
|
136.11
|
101
|
2726.11
|
-56.47
|
Total
|
19387
|
7110.29
|
-2604.34
|
14694
|
6839.07
|
-549.93
|
16366
|
6269.08
|
945.69
|
According to Table 1 and Table 2, the overall situation of the obstetric expenditure in 2020 and 2021 was in deficit, with 14 and 8 overspending diseases respectively, and 5 and 11 disease groups with a surplus respectively. In 2022, the overall situation of the obstetrics department was in surplus, with 7 overspending disease groups and 12 disease groups with a surplus. DRG operations have improved year by year. The Boston matrix graph was used to further analyze the obstetric DRG disease group. The Boston matrix graph was divided into four regions: high-weight surplus, high-weight overspend, low-weight overspend, and low-weight surplus (Figure 1). The high-weight balance area contained only two disease groups, OB 15 (cesarean section without comorbidities or complications) and OB 13 (cesarean section with general comorbidity or complications). The low-weight balance region had 10 disease groups, among which the highest average surplus cost was 1135.25 yuan for disease group OR 11 (vaginal delivery with severe complications or comorbidities), with only 94 cases treated. In the high-weight overspend region, there were 5 disease groups distributed, while there were 17 disease groups in the low-weight overspend region. The top five cases of all overruns were OC19 (vaginal delivery with surgical procedure, painless), OZ 13 (other pregnancy-related disorders, with general complications and comorbidities), OC11 (vaginal delivery with surgical procedures, with severe complications and comorbidities), OF 13 (midterm labor induction procedure, with general complications and comorbidities), and OD 23 (vulval, vaginal, and cervical surgery related to pregnancy, with general complications and comorbidities), with average overspend costs of 618.21 yuan, 146.10 yuan, 143.41 yuan, 535.45 yuan, and 926.14 yuan, respectively. Among them, the OZ 13 disease group was taken as an example for the subsequent cost structure analysis because of its lowest weight (Figure 1).
2.2 Basic information of the patients in the OZ 13 disease group
A total of 7633 cases of the OZ 13 disease group were included in this study, with their disease information and hospitalization costs shown in Table 3. The older the patients admitted to this disease group are, the higher the medical costs. Among them, there were 2,878 cases (38.10%) under the age of 30 (excluding), 4634 cases (61.30%) between the ages of 30 to 40, and only 48 cases (0.60%) over the age of 40 (excluding). Besides, only 75.80% of the cases had a hospital stay of less than or equal to 5 days, 21.70% of the cases had hospitalization days between 6 to 15 days, and only 2.5% of the cases had a hospital stay of more than 15 days. However, the hospitalization cost of these cases was much higher than that of the cases stayed for less than or equal to 5 days. Among the cases admitted, 24.60% were mainly diagnosed as threatened preterm birth without delivery and 5.5% were mainly diagnosed as fetal growth retardation. Cases with primary diagnoses such as diabetes, oligohydramnios, and intrahepatic cholestasis during pregnancy, which accounted for no more than 4%, were assigned to other diagnoses. The hospitalization costs for threatened preterm birth and fetal growth retardation were higher than those for other primary diagnoses (Table 3).
Table 3. Basic information on patients and hospitalization costs
variable
|
Case
|
Rate (%)
|
Median hospitalization cost (yuan)
|
median drug cost (yuan)
|
Age (year)
|
|
|
|
|
<30
|
2878
|
38.10
|
1833(1396,2791)
|
269(56,701)
|
30-40
|
4634
|
61.30
|
1864(1393,2774)
|
265(56,696)
|
>40
|
48
|
0.60
|
2070(1519,3277)
|
468(106,806)
|
Day of hospitalization (day)
|
|
|
|
|
≤5
|
5789
|
75.80
|
1607(1297,2066)
|
154(27,405)
|
6-15
|
1659
|
21.70
|
3610(2775,4815)
|
982(574,1602)
|
16-30
|
141
|
1.80
|
8428(6279,10637)
|
2716(1442,4458)
|
31-45
|
27
|
0.40
|
14338(11630,18070)
|
5106(3130,7497)
|
46-60
|
10
|
0.10
|
17573(15245,25755)
|
4997(4023,9305)
|
≥61
|
7
|
0.10
|
29469(18261,38312)
|
10107(6261,18668)
|
Primary diagnostic encoding
|
|
|
|
|
other
|
5334
|
69.90
|
1787(1357,2620)
|
227(33,629)
|
Semde premature birth without delivery
|
1879
|
24.60
|
1832(1433,2619)
|
262(83,594)
|
Fetal growth and development retardation
|
420
|
5.50
|
3578(2721,4858)
|
1014(717,1638)
|
2.3 Hospitalization costs and patient medication status
The average hospitalization cost of patients in the OZ 13 group was 2577.48 yuan, with the highest proportion being spent on examinations, accounting for 47.82%. The results of Spearman correlation analysis showed a positive correlation between various factors and hospitalization costs (P <0.01), with the highest correlation coefficient of drug costs being 0.797 (Table 4). Based on the analysis results, a further detailed analysis of the drug use status and drug cost of the disease group is performed.
Table 4. Hospitalization costs and correlation in the OZ13 disease group
expense classification
|
Average value (yuan)
|
Median (yuan)
|
Rate (%)
|
Correlation with hospitalization costs
|
Drug costs
|
640.21
|
268.00
|
24.99
|
0.797**
|
Consumables
|
95.66
|
74.00
|
3.73
|
0.722**
|
Inspection fee
|
1225.17
|
1040.00
|
47.82
|
0.722**
|
Medical service fee
|
441.55
|
332.00
|
17.23
|
0.792**
|
miscellaneous expenses
|
174.89
|
120.00
|
6.83
|
0.757**
|
Total
|
2577.48
|
1834.00
|
100.60
|
** P≤0.05
|
Drug categories were counted according to the amount of obstetric prescription names and the number of people. The results showed that the top 14 drug categories in terms of average cost per use for this disease group were β-lactam antibiotics, plasma and blood volume expansion, leukocytotropic drugs, anticoagulants, nutritional supplements, adjuvant drugs for hepatobiliary disease, anti-preterm labor drugs, oxytocin, electrolyte and acid-base balance medications, macrolides, progesterone drugs, drugs for digestive system diseases, hypoglycemic drugs, and anti-anemia drugs. Among them, anti-preterm labor drugs had the highest frequency and the highest total amount, reflected in Table 5. Therefore, the medication data of cases were analyzed horizontally and vertically in terms of the use frequency of anti-preterm drugs, drug cost, and combined utilization rate.
Table 5. Top 14 types of prescription drugs in the OZ13 group
Drug category
|
Amount (yuan)
|
The number of people
|
Sort of an average amount
|
Anti-preterm drugs
|
1504046.82
|
6671
|
7
|
nutriceutical
|
676331.61
|
1315
|
4
|
anticoagulant
|
613549.81
|
1069
|
3
|
Adjunctive therapy for hepatobiliary diseases
|
574390.99
|
1333
|
5
|
Progesterone
|
404867.38
|
2849
|
11
|
Medication for digestive system diseases
|
346676.87
|
2612
|
12
|
β -Lactam antimicrobials
|
354759.3
|
1169
|
6
|
Anti-anemic
|
219774.95
|
1837
|
14
|
Plasma and blood volume augmenting agents
|
52080.00
|
38
|
1
|
Blood glucose-lowering drugs
|
38096.12
|
288
|
13
|
drug for increasing white cells
|
11502.62
|
14
|
2
|
Adjust the water, electrolyte, and acid-base balance
|
9929.89
|
50
|
9
|
macrolides
|
9129.86
|
61
|
10
|
oxytocin
|
8873.01
|
43
|
8
|
2.4 Anti-preterm drug use in the OZ 13 disease group
Among the anti-preterm labor drugs used in the OZ 13 disease group (as shown in Table 6), the most commonly used was ritodrine hydrochloride (including injections and tablets), followed by 25% magnesium sulfate injection and atosiban injection. The cross-sectional comparison of the use of anti-preterm labor drugs among different physicians for cases in the OZ 13 group found that the drug use varied among different physicians during the treatment, with 8 medical groups having a higher rate of anti-preterm drug utilization than the overall department level, and the OZ 13 group were overrun in 2022. In 2022, 3623 cases were distributed in 20 medical groups. The group with the most cases treated 258 patients, with a usage rate of 57.75% for anti-preterm drugs and a combined usage rate of 19.77%. The group with the fewest cases treated 24 patients, with a usage rate of 20.83% for anti-preterm drugs and a combined usage rate of 4.17%. The group with the highest usage rate of anti-preterm drugs treated 203 cases, with a combined usage rate of 24.63%, and had an overrun of 55,043.45 yuan.
Table 6. Application of anti-preterm drugs by different doctors in the OZ13 disease group
medical group
|
Case
|
Medical cost per time (yuan)
|
Overspend/remaining balance amount (yuan)
|
Average hospital stay (days)
|
Number of anti-preterm drug combinations used
|
Amount of secondary anti-preterm drug (yuan)
|
Times of anti-preterm drug use (days)
|
Antipreterm drug utilization rate
|
Combination use of anti-preterm drugs
|
Group1
|
203
|
2582.09
|
-55043.45
|
4.79
|
50
|
175.75
|
3.88
|
56.16%
|
24.63%
|
Group2
|
191
|
2457.66
|
-57386.65
|
3.72
|
38
|
189.79
|
2.43
|
54.97%
|
19.90%
|
Group3
|
258
|
2706.03
|
-73264.43
|
4.04
|
51
|
440.78
|
2.66
|
57.75%
|
19.77%
|
Group4
|
249
|
2337.02
|
-29789.57
|
4.48
|
45
|
136.52
|
3.39
|
55.02%
|
18.07%
|
Group5
|
175
|
2587.65
|
-62953.63
|
4.31
|
29
|
116.71
|
2.97
|
40.00%
|
16.57%
|
Group6
|
228
|
2369.91
|
-44141.65
|
3.26
|
35
|
59.85
|
1.70
|
47.37%
|
15.35%
|
Group7
|
179
|
2280.52
|
-28570.11
|
4.35
|
26
|
80.40
|
2.17
|
51.40%
|
14.53%
|
Group8
|
202
|
2829.67
|
-90857.09
|
4.01
|
29
|
325.52
|
2.96
|
63.86%
|
14.36%
|
Group9
|
217
|
2842.44
|
4221.21
|
3.55
|
31
|
729.07
|
2.63
|
48.39%
|
14.29%
|
Group10
|
163
|
2268.87
|
-8897.13
|
3.64
|
23
|
284.59
|
2.71
|
50.92%
|
14.11%
|
Group11
|
232
|
2374.30
|
-42041.97
|
3.53
|
26
|
112.97
|
1.50
|
40.09%
|
11.21%
|
Group12
|
145
|
2290.76
|
-15172.61
|
4.19
|
16
|
83.71
|
2.27
|
40.69%
|
11.03%
|
Group13
|
171
|
2068.80
|
18864.84
|
4.08
|
18
|
101.13
|
2.04
|
43.86%
|
10.53%
|
Group14
|
77
|
2148.44
|
3378.68
|
4.14
|
8
|
101.40
|
3.16
|
71.43%
|
10.39%
|
Group15
|
213
|
2250.80
|
-26746.87
|
3.99
|
22
|
134.18
|
2.19
|
46.48%
|
10.33%
|
Group16
|
120
|
2031.55
|
19543.16
|
4.33
|
12
|
48.67
|
1.61
|
47.50%
|
10.00%
|
Group17
|
232
|
2101.24
|
29845.7
|
3.53
|
22
|
110.90
|
1.66
|
41.81%
|
9.48%
|
Group18
|
190
|
2243.82
|
257.66
|
3.99
|
16
|
136.10
|
2.32
|
57.37%
|
8.42%
|
Group19
|
154
|
2843.75
|
-83953.2
|
4.79
|
11
|
111.40
|
2.65
|
39.61%
|
7.14%
|
Group20
|
24
|
4010.68
|
10141.23
|
2.58
|
1
|
2469.57
|
2.54
|
20.83%
|
4.17%
|
Total
|
3623
|
2430.77
|
-532565.88
|
4.00
|
509
|
210.97
|
2.46
|
49.74%
|
14.05%
|
The monthly longitudinal comparison of the OZ 13 disease group’s discharged cases from January to December 2022 found that the change in anti-preterm medication use in the OZ 13 disease group was small relative to the number of discharges. In August 2022, the number of cases using anti-preterm drugs reached its peak at 238, accounting for 61.82% of the discharged cases. The least number of cases using anti-preterm drugs was recorded in February, with 95 cases, which accounted for 57.58% of the discharged cases. In February 2022, the consumption amount of anti-preterm drugs was the highest, amounting to 193413.27 yuan; while in December, the amount spent on anti-preterm drugs was the lowest, at 29092.27 yuan. The changes in anti-preterm drugs in the OZ 13 disease group from January to December 2022 are shown in Figure 2. In May 2022, the number of patients using anti-preterm medication in the OZ 13 group was slightly higher, accounting for 63.67% of the discharges, probably due to the relatively fewer discharge cases in this DRG group in May.