25 June 2023, Volume 30 Issue 3

    

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  Path thinking of public hospital performance management under the background of DRG/DIP payment mode reform

   

  Xu Xiaoming，Zhao Shengtian

  journal1. 2023, 30(3): 161-165. https://doi.org/10.3969/j.issn.1006-5253.2023.03.001

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  The implementation of the “14th FiveYear Plan” national medical security plan has accelerated the pace of perfecting the multi-tiered medical security system, continuously improved the medical insurance payment mechanism, and announced the implementation of the DRG/DIP payment mode reform three-year action plan in order to improve the quality, reduce the cost and increase the efficiency of the medical insurance funds. Medical insurance payment policy is closely related to performance management of hospitals. Therefore, this paper analyzes the impact of DRG/DIP payment reform on performance management of public hospitals from the perspective of performance management. And from the five aspects of cost accounting and analysis, talent construction, performance evaluation system construction, information construction and culture construction, it explores the performance management path of public hospitals under the background of DRG/DIP payment, and puts forward targeted suggestions for the performance managemet of public hospitals, in order to inject momentum into the high-quality development of public hospitals.

   
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  Associations of cognitive impairment with education status and mortality risk based on a Chinese elderly cohort

   

  Wu Jingyi，Deng Wei， Yu Yongfu

  journal1. 2023, 30(3): 166-172. https://doi.org/10.3969/j.issn.1006-5253.2023.03.002

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  Objective To explore the association of cognition impairment with education status and mortality among the Chinese elderly and to provide recommendations for cognitive management of the Chinese elderly.Methods The study population was from the elderly aged 65 and above in the Chinese longitudinal healthy longevity survey (CLHLS) in 2005 and 2008. The traditional Cox proportional hazard model and additive Cox proportional hazard model were used to estimate the associations of cognitive impairment with education status and all-cause mortality. Data analysis included univariable analysis, stratified analysis and interaction analysis. The additive Cox proportional hazard model results were presented in the form of images.Results Among 15 860 eligible participants included in the study, 11 044 died during follow-up. The results showed that cognitive impairment would increase the mortality risk of the elderly (HR=1.32, 95%CI:1.26-1.39). And after stratified by education status, the hazardous effects diminished as education status decreased (years of schooling >6 years HR=1.47, 95%CI: 1.08-2.00; years of schooling 1-6 years HR=1.44, 95%CI: 1.26-1.63; years of schooling 0 year  HR=1.32, 95%CI:1.25-1.39). In addition, the association of education status and mortality was inconsistent across cognitively diverse populations. The protective effect of education status on mortality was observed among the people with normal cognitive function (HR=0.83, 95%CI: 0.77-0.91) but not observed among the people with cognitive impairment (HR=1.09, 95%CI: 0.81-1.47).Conclusion It is suggested that the community health centers should manage the cognitive function of the elderly according to their education status.

   
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  Application of ARIMA multiplicative seasonal model in predicting the epidemic trend of carbapenem resistant Klebsiella pneumoniae

   

  Zhang Qiping， Ji Conghua，Lu Jinqi， Wang Xiaoteng

  journal1. 2023, 30(3): 173-178. https://doi.org/10.3969/j.issn.1006-5253.2023.03.003

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  Objective To explore the application value of autoregressive integrated moving average (ARIMA) multiplicative seasonal model in predicting the epidemic trend of carbapenem resistant Klebsiella pneumoniae (CRKP), and to provide a theoretical basis for grasping the epidemic trend and formulating prevention and control measures of CRKP infection in hospitals.Methods Based on the monthly number of CRKP detected in a tertiary hospital in Jiaxing City from 2016 to 2021, the ARIMA multiplicative seasonal model was constructed with SPSS 26.0 software. The actual number of CRKP plants detected in 2022 was selected as the validation data set and compared with the predicted value, so as to evaluate the prediction efficiency of the model.Results The total number of CRKP detected in hospital showed a downward trend year by year from 2016 to 2021. The incidence was concentrated from July to September, and the peak was in September, which was seasonal and periodic. The Bayesian information criterion (BIC) of the fitted ARIMA (0, 1, 2) (0, 1, 0)12 was 0.43, and the mean absolute percent error (MAPE) was 16.54. The difference of Ljung-box test of model residual sequence was not statistically significant (Q=11.06, P=0.81). The residual sequence was white noise, indicating that the model fitted well and was determined as the optimal model. The number of CRKP strains detected from January to December 2022 was used to verify the prediction effect of the model. The results showed that the actual incidence trend was in good agreement with the prediction curve, and the actual values were all within the 95% confidence interval of the predicted values, the prediction error was -33.33%25.00%, and the average relative error was 15.56%, indicating that the prediction effect of the model was good.Conclusion ARIMA multiplicative seasonal model can fit the time change of the number of CRKP detected in the hospital well, so it can be used for short-term prediction and dynamic analysis of CRKP epidemic trend, and provide basis for the early warning and prevention of CRKP infection in hospitals.

   
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  Dynamic analysis and prediction of surgical operation volume in a municipal general hospital based on seasonal index method

   

  Niu Wenyan, Liu Haitao, Wu Tingting

  journal1. 2023, 30(3): 179-182. https://doi.org/10.3969/j.issn.1006-5253.2023.03.004

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  Objective To find out the dynamic change rule of surgical operation volume in a hospital from 2011 to 2020 through statistical analysis, so as to provide information reference for hospital management and medical resource allocation.Methods The moving average seasonal index method was used to dynamically analyze the surgical volume data from 2011 to 2020 and establish a prediction model.Results Except for the decline in 2020 due to the COVID-19 epidemic, the number of surgical operations in other years has increased to varying degrees, with a cumulative increase of 227.27% and an average growth rate of 8.56% per year in 10 years. In the second and third quarters of a year, the number of operations was more, and the seasonal index was more than 100%. The number of operations in the first and fourth quarters was small, and the seasonal index was lower than 1.Conclusion The number of surgical operations in the hospital has obvious regularity with seasonal changes. Hospital managers should reasonably allocate medical resources according to the change and development rules of surgical operations to ensure medical safety and service efficiency.

   
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  Construction of prognostic model of nonsmall cell lung cancer patients with brain metastases

   

  Bian Houlei，Gao Xuejun

  journal1. 2023, 30(3): 183-190. https://doi.org/10.3969/j.issn.1006-5253.2023.03.005

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  Objective Patients with non-small cell lung cancer (NSCLC) complicated with brain metastases (BM) have poor prognosis. This study aimed to evaluate the prognostic factors of BM in newly diagnosed NSCLC patients and construct a nomogram to predict the overall survival (OS).Methods We included NSCLC patients with BM diagnosed from 2010 to 2016 in SEER and they were randomly divided into the modeling group and the validation group at 7∶3. The independent prognostic factors for NSCLC with BM were determined by Cox proportional hazard regression analysis. R software was used to construct a nomogram and evaluate its differentiation, consistency and effectiveness, and finally draw a 1-3 year survival curve.Results We finally included 6 102 NSCLC patients with BM for analysis. Age, race, gender, histologic type, liver metastasis, lung metastasis, bone metastasis, Grade grading, T staging, N staging, surgery, chemotherapy and radiotherapy were identified as the prognostic factors for NSCLC with BM and integrated to establish the nomogram. The calibration, receiver operating characteristic curve, and decision curve analyses also showed that the clinical prediction model performed satisfactorily in predicting prognosis.Conclusion The construction of a clinical prediction model could effectively predict the overall survival of patients with NSCLC with BM, which has guiding significance for clinicians and patients.
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  Research on comprehensive evaluation method in departments of TCM hospitals based on ordinal advance and retreat method and rank sum ratio method

   

  Guo Huijun，Li Dan，Zhu Huidong，Yang Yanjie

  journal1. 2023, 30(3): 191-197. https://doi.org/10.3969/j.issn.1006-5253.2023.03.006

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  Objective To explore evaluation methods suitable for the comparison between departments in a TCM hospital, according to the evaluation system of modern TCM hospitals.Methods The evaluation index system was constructed based on "performance evaluation index of national tertiary public traditional Chinese medicine hospitals", and ordinal advance and retreat method and rank sum ratio method were combined to carry out comprehensive evaluation and ranking of various departments of a TCM Hospital in Beijing.Results The 35 departments in the hospital are divided into three categories: the first level excellent departments include 6 departments such as ZWBK and EBHK, the second level departments include 24 departments such as EK and ZLK, and the third level general departments include 5 departments such as WEK and GSK.Conclusion The comprehensive evaluation index system built in this paper, which combines ordinal advance and retreat method and the rank sum ratio method, can well evaluate the clinical departments of TCM hospitals, clearly show the strengths and weaknesses of each department, and provide support for giving full play to the role of performance assessment baton.
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  Health economics research on robotassisted radical gastrectomy for gastric cancer in a hospital in Jiangsu Province

  Zhang Xiaochun，Shen Danli，Gong Guanwen，Jiang Zhiwei

  journal1. 2023, 30(3): 198-202. https://doi.org/10.3969/j.issn.1006-5253.2023.03.007

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  Objective To analyze the cost and postoperative rehabilitation of patients with gastric cancer undergoing robot-assisted therapy, and to evaluate the health economics of Da Vinci robot-assisted radical gastrectomy, traditional gastrectomy and laparoscopic-assisted radical gastrectomy in a hospital in Jiangsu Province.Methods One hundred and thirteen patients who underwent radical gastrectomy for gastric cancer in the general surgery department of Jiangsu Hospital of Traditional Chinese Medicine from July 1, 2020 to July 31, 2021 were selected as the study subjects, and were divided into 3 groups according to surgical methods: the robot-assisted laparoscopic radical gastrectomy for gastric cancer group (n=46), the traditional gastrectomy group (n=26), and the laparoscopic radical gastrectomy group (n=41). The cost, cost structure and postoperative rehabilitation indexes of the three groups of patients were compared and analyzed.Results 1) There were significant differences in the total cost, drug cost, especially Western medicine cost, surgical consumables cost, diagnosis and treatment service cost, and inspection cost between the robot group and the open surgery group and the laparoscopic group (P＜0.05). The decrease of drug cost in the robot group was the largest, and the difference was statistically significant (P<0.05)  2) In the robot group, the ventilation time (3.02±0.33)d, defecation time (4.00±0.29)d, first oral feeding time (1.80±0.36)d, catheter removal time (0.78±0.61)d and postoperative discharge days (5.72±0.70) were significantly advanced (P＜0.05). There was no significant difference in the incidence of postoperative complications (P＞0.05). 3) There was a statistically significant difference in out-of-pocket payment between the robot group and the traditional surgery group (P＜0.05).Conclusion Da Vinci robot-assisted radical gastrectomy significantly reduced the drug cost of patients, greatly reduced hospital stay and achieved rapid recovery, and was as safe and effective as traditional surgery and laparoscopic techniques. It is inevitable and necessary to implement Da Vinci robotic surgery under the background of the new medical reform, which could improve the quality of medical services and save medical and health resources. 
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  Evaluation on standardized time efficiency and bed efficiency model for clinical departments on DRG performance management

  Zhou Meizhen，Zheng Pan，Guo Jiayi，Xu Minhui，Li Xiaobing，Hu Min

  journal1. 2023, 30(3): 203-207. https://doi.org/10.3969/j.issn.1006-5253.2023.03.008

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  Objective To analyze the practical application of DRG performance grouping standardized time and bed efficiency model to clinical departments, to effectively avoid the impact of different disease structures on efficiency and productivity, and to provide basis for hospital bed management and related medical resources allocation.Methods Patients discharged from the pediatric department in a municipal maternal and child health care institution in Zhejiang Province were selected as the research subjects. DRG group was combined with the specialized data, and the average hospitalization days and bed utilization rate were standardized by direct standardization method. The standardized results of the coverage of all the diseases were measured and compared with the traditional indicators. Time bed efficiency model was used to analyze time efficiency and bed efficiency.Results In the first half of 2021, the average hospitalization days and bed utilization rate of the first pediatrics department were different in the three groups of traditional, standardized and standardized coverage of all diseases; the first and second quarter values of the utilization rate of standardized beds in the first pediatrics department and standardized beds for full-coverage diseases were 45.08%, 84.17% and 56.38%, 84.64% respectively. The time and bed efficiency model showed that the three specialties in the second quarter were improved compared with those in the first quarter; the first pediatrics department was in the quadrant of high efficiency and efficiency, with an operation score of 2.25.Conclusion Standardized average hospital stay and bed utilization rate can promote the refined management of DRG in medical institutions and other evaluation institutions. The time-bed efficiency model can reflect resource usage more accurately and comprehensively, which is helpful for government departments and hospital managers to make development plans.

   
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  Analysis on hospital bed utilization efficiency in 11 cities of Zhejiang Province

  Lü Na，Xu Shanshan，Lü Ye, Li Chaokang，Xu Hong

  journal1. 2023, 30(3): 208-210. https://doi.org/10.3969/j.issn.1006-5253.2023.03.009

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  Objective To analyze and evaluate the hospital bed efficiency in 11 cities of Zhejiang Province.Methods Four indexes, including the number of hospital bed turnover, the working days of hospital bed, the utilization rate of hospital beds and the average hospitalization days, were collected from 11 cities of Zhejiang Province and evaluated comprehensively with TOPSIS method. Results The average number of hospital bed turnover was 28.6 times, the working days of beds was 281.3 days, the utilization rate of bed was 76.9%, and the average hospitalization days was 9.7 days in 2020. The top 3 cities with the highest bed utilization efficiency were: Taizhou, Jinhua and Huzhou, with evaluation scores of 0.871, 0.835 and 0.803, respectively. The bottom 3 cities were: Zhoushan, Lishui and Wenzhou, with evaluation scores of 0.000, 0.295 and 0.387, respectively.Conclusion In order to realize the reasonable allocation of bed resources and to improve the hospital bed efficiency, it is suggested to give full play to the overall coordination role of the government in the allocation of bed resources, optimize the dynamic allocation mechanism of beds within hospitals, strengthen the linkage between hospitals and grass-roots medical institutions, and improve the level of medical technology and management.
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  Screening of priority day surgery types in a tertiary general hospital in Sichuan Province

  Huang Qin，Xu Chiheng，Chen Xinyu

  journal1. 2023, 30(3): 211-215. https://doi.org/10.3969/j.issn.1006-5253.2023.03.010

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  Objective To assess the efficacy of day surgery in reducing the hospitalization duration and cost for different diagnosis-related groups (DRGs) in a tertiary general hospital situated in Sichuan Province and to provide crucial evidence to facilitate the identification of suitable types of day surgery for screening purposes.Methods The information of patients undergoing surgery in a hospital from June 2021 to May 2022 was retrospectively analyzed, and the relevant data during the treatment period were collected. Patients who did not perform the day surgery mode were taken as the control group, and patients who performed the day surgery mode were taken as the observation group. SPSS was used to analyze the relevant indicators and hospitalization costs during the treatment of the two groups, and DRG evaluation system was used for evaluation.Results There were 1 621- patients including 543 patients with day surgery, and 1 078 hospitalized patients with elective surgery. In terms of hospital stay, day surgery was lower than elective surgery in hospital, and the difference was statistically significant (P<0.05). In terms of hospitalization costs, there was no statistically significant difference observed between the two groups in blepharon adhesion separation and extensor tendon suture (P>0.05). However, a significant difference was observed between the two groups for other surgical procedures (P<0.05). In terms of day/hospital choice composite index, the composite indexes of urethral lesion resection, transurethral ureteral stenting and fracture internal fixation removal were all<0.1, and the composite indexes of other procedures were all≥0.1 and <0.5.Conclusion Based on the assessment of the day/hospital choice comprehensive index, surgical procedures with lower index values can be prioritized for day surgery while maintaining the same level of safety. Conversely, surgical procedures with higher index values can be classified as general operations.

   
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  Analysis of influencing factors on hospitalization expenses of cesarean scar pregnancy patients in a tertiary hospital

  Li Cuiling，Zhang Dongfeng，Hu Xiaojuan，Zhou Rui

  journal1. 2023, 30(3): 216-221. https://doi.org/10.3969/j.issn.1006-5253.2023.03.011

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  Objective To analyze the influencing factors of hospitalization costs for cesarean scar pregnancy and provide a basis for reasonable cost control in clinical practice.Methods  A study was conducted on patients with cesarean scar pregnancy who were discharged from a hospital in Shandong Province from January 2019 to July 2022. Statistical methods such as descriptive analysis, Chi-square test, Fisher's exact probability method, rank sum test, and multiple linear regression analysis were used for the study.Results Finally 327 patients with CSP were enrolled in the study. The total hospitalization expenses showed a fluctuating downward trend, with a median of 4 364.65 yuan and an average annual growth rate of 3.04%. The drug cost showed a continuous upward trend, with an average annual growth rate of 9.96%. There were statistically significant differences in hospitalization expenses among hospital stay, gestational age, comorbidities, anesthesia methods, and surgical types (P<0.05). Multiple linear regression analysis showed that the main influencing factors of hospitalization expenses were anesthesia method, surgical type, length of hospital stay, and gestational age (P<0.05).Conclusion It is clinically necessary to further reduce hospitalization costs for CSP patients by early diagnosis and treatment, reasonable selection of surgical types and anesthesia methods, and scientific reduction of hospital stay. 
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  Investigation and analysis on awareness of core information of chronic disease prevention and control in Mentougou District of Beijing

  Li Chaonan

  journal1. 2023, 30(3): 222-225. https://doi.org/10.3969/j.issn.1006-5253.2023.03.012

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  Objective To analyze the awareness of residents′ core information of chronic disease prevention and control and its influencing factors in Mentougou District of Beijing, so as to provide scientific basis for chronic disease prevention and control.Methods In April, 2021, 1 735 permanent residents over 18 years old were randomly sampled in Mentougou District. The questionnaire was used to investigate the knowledge of core information of chronic disease prevention and control, including basic personal information and core knowledge of chronic disease prevention and control. SPSS 22.0 software was used for chi-square test and multivariate logistic regression analysis.Results The awareness rate of core knowledge of chronic disease prevention and control in Mentougou District residents was 65.76%, and there were statistically significant differences in awareness rates among different genders, ages, urban and rural areas, education levels, and occupation (P<0.01). Multivariate logistic regression analysis showed that male (OR=0.801), young population (under 40 years old OR=1.455), rural population (OR=0.686), low educational levels (junior middle school OR=0.475, high school OR=0.536) and manual workers (OR=0.665) had a poor performance in core knowledge answering.Conclusion Residents in Mentougou District of Beijing have a good knowledge of the core knowledge of chronic disease prevention and control, and various chronic disease prevention and control measures should be taken for the key population.
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  Construction of evaluation index system of health education and behavior intervention on AIDS for college students

  Chen Yumei，Sun Cong，Chu Tianci，Zhu Sijin，Shao Xiao，Hu Naibao

  journal1. 2023, 30(3): 226-231. https://doi.org/10.3969/j.issn.1006-5253.2023.03.013

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  Objective To construct a scientific and reasonable evaluation index system of AIDS health education and behavior intervention for college students, and improve the level of AIDS prevention and control among college students.Methods On the basis of literature review and policy interpretation, the basic framework of index system was constructed. Delphi method and hierarchical analysis were used to demonstrate the index system and determine the weight.Results An evaluation index system consisting of 4 first-level indicators, 9 second-level indicators and 27 third-level indicators was constructed. The weights of first-level indicators were “behavioral tendency”, “behavioral change”, “behavioral reinforcement” and “behavioral promotion” from high to low.Conclusion The hierarchical structure model has good consistency, and the index weight level is clear. The evaluation-index system has comprehensive content, closely related to the pattern of all-round health education, and is scientific and reliable.
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  Meta-analysis of timolol eye drops in the treatment of superficial hemangioma in infants

  Xu Jinlong，Ye Jiaxing，Chen Wu，Ma Weicheng

  journal1. 2023, 30(3): 232-235. https://doi.org/10.3969/j.issn.1006-5253.2023.03.014

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  Objective To study the meta-analysis of timolol eye drops in the treatment of superficial hemangioma in infants.Methods Randomized controlled trials (RCTs) of timolol eye drops in the treatment of superficial infantile hemangioma were retrieved. Literature was screened, data were extracted and research quality was evaluated with RevMan 5.3 software and Stata 11.0 software.Results Seven studies involving 706 patients were included. The results of meta-analysis showed that the effective rate and marked efficiency of timolol eye drops in the treatment of superficial hemangioma in infants were significantly higher than those in the control group (P<0.001), while the incidence of ADR was not significantly different (P=0.570). Compared with infants aged less than 6 months and over 6 months, the control rate was not significantly different (P=0.380), but the regression rate was significantly higher (P=0.004).Conclusion Timolol eye drops are safe and effective in the treatment of superficial infantile hemangioma, and the effect is better in infants aged less than 6 months. 
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  Hotspots and situation of DRG research in China with social network method

  Li Yunfeng，Yang Yechun，Xiang Ping，Hu Wei

  journal1. 2023, 30(3): 236-240. https://doi.org/10.3969/j.issn.1006-5253.2023.03.015

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  Objective To understand the current status and hotspots of DRG research in China in order to provide reference for the focus and direction of subsequent research.Methods The literatures related to DRG were retrieved from China National Knowledge Network (CNKI). Descriptive analysis was made on the number of DRG literatures and the years of publication. Social network analysis was used to analyze the core authors, cooperative groups, high-frequency keywords and their relationships in DRG literatures.Results There were 2 602 journal articles with the theme of ‘DRG’ or ‘diagnosis related groups’. After 2015, the number of DRG literatures in China showed a multiple increase, with the annual literatures in 2021 and 2022 exceeding 500. There were 1 072 articles from core journals (41.20%) and 1 530 articles from non-core journals (58.80%). There were 188 core authors in the field of DRG research, mainly forming 7 cooperative groups led by Hu Mu and Guo Moning, with a total of 1 425 publications (54.77%). The network cograph and centrality analysis of high-frequency keywords showed that payment method, DRG prepaid, first page of medical records , hospital management, hospitalization cost and performance evaluation were the high-frequency keywords in the field of DRG research, and their point degree centrality and proximity centrality ranked first. However, the first page of medical records and CMI were more mediation-centered.Conclusion The number of literatures in the field of DRG research increases rapidly in recent years, but the quality of literatures needs to be evaluated and improved. The core authors are relatively concentrated and have strong overall influence and academic leading role. The research hotspot of DRG focuses on DRG payment and DRG performance evaluation and hospital management.