Exploration of clinical pathway practice for optimization of DRG costing results based on resource consumption.

Abstract

Background: China's Diagnosis-Related Groups (DRGs) payment reform focuses on clinical pathway standardization and cost accounting to optimize resource use. Mengchao Hepatobiliary Hospital (MC Hospital), a tertiary care institution and DRG pilot site, implemented a "double helix model" integrating cost accounting with clinical pathway optimization.

Methods: A retrospective analysis of data extracted from the hospital cost system was conducted in 2022 at a tertiary hospital in China. The study integrated Hospital Information System (HIS), Laboratory Information Management System (LIMS), and Hospital Resource Planning (HRP) systems into a centralized cost data hub. The equivalent coefficient approach was applied to calculate medical service costs based on labor inputs, procedural complexity, and risk levels. Costs of DRGs, including services, pharmaceuticals, and consumables, were aggregated through item-wise summation. A double helix model was developed to iteratively optimize clinical pathways by linking cost variance analysis with pathway adjustments.

Results: The intervention achieved a 44.56% cost reduction (¥4,000 per case) and reduced average hospitalization duration from 17.8 to 12.8 days, and infection rates dropped by 4.12%. Efficiency: High-performing departments (e.g., 9.45-day stays) showed lower cost variance. Traditional Chinese Medicine (TCM) Integration: Usage increased 3.7% without compromising treatment costs.

Conclusions: The double helix model effectively aligns cost accounting with clinical pathways, reducing expenses while maintaining health quality. While effective, its adoption requires alignment with institutional capabilities and regional resource realities. It requires advanced health information technology (HIT), and is less effective for homogeneous treatments.