A Bibliometric Analysis of Diagnosis Related Groups from 2013 to 2022

Figures & data

Figure 1 The process of literature screening.

Figure 2 (A) Yearly output and score; (B) Distribution of global publications in the field of DRGs; (C) Academic cooperation networks between countries/regions.

Table 1 The Top 10 Productive Countries in the Studies

Rank	Country	Region	Recs	Percentage	TGCS	ACI
1	USA	North America	549	31.75	8922	16.25
2	Germany	Central Europe	497	28.74	4190	8.43
3	Italy	South Europe	125	7.23	1354	10.83
4	Australia	Oceania	97	5.61	1077	11.10
5	Switzerland	Central Europe	95	5.49	865	9.11
6	France	Western Europe	87	5.03	1055	12.13
7	Spain	South America	87	5.03	569	6.54
8	UK	Western Europe	77	4.45	692	8.99
9	China	East Asia	73	4.22	299	4.10
10	Portugal	Southwest Europe	42	2.43	462	11.00

Abbreviation: Recs, Records.

Table 2 The Top 10 Institutions (Based on Records and TGCS Respectively)

Rank	Institution	Country	Recs	TGCS	ACI
1	New York University	USA	17	536	31.53
2	Hannover Medical School	Germany	18	487	27.06
3	University of Michigan	USA	17	483	28.41
4	Tech University Berlin	Germany	24	472	19.67
5	Johns Hopkins University	USA	16	442	27.63
6	Jena University Hospital	Germany	10	397	39.70
7	Harvard University	USA	14	387	27.64
8	Technical University of Munich	Germany	34	381	11.21
9	The University of Iowa	USA	11	375	34.09
10	University of Washington	USA	20	375	18.75

Table 3 The Top 15 Journals (Based on TGCS)

Rank	Journal	Recs	TGCS	ACI	IF (2022)
1	Journal of Trauma and Acute Care Surgery	20	712	35.6	3.697
2	Journal of Arthroplasty	34	602	17.71	4.435
3	Jama-journal of the American Medical Association	5	597	119.4	157.375
4	BMC Health Services Research	55	561	10.2	4.435
5	Deutsches Arzteblatt International	12	530	44.17	8.251
6	Health Policy	33	464	14.06	3.255
7	PLoS One	33	432	13.09	3.752
8	Pharmacoepidemiology and Drug Safety	3	317	105.67	2.732
9	Journal Of Bone and Joint Surgery-American Volume	8	309	38.63	6.558
10	Jama Surgery	4	291	72.75	16.685
11	Clinical Orthopaedics And Related Research	8	256	32	4.837
12	BMJ Open	18	240	13.33	3.007
13	Journal of Vascular Surgery	18	215	11.94	4.86
14	Respiratory Care	2	189	94.5	2.339
15	Pediatrics	7	174	24.86	9.703

Figure 3 (A) Academic cooperation networks between institutions; (B) Academic cooperation networks between authors.

Table 4 The Top 20 Keywords

Rank	Keywords	Count	Centrality	Rank	Keywords	Count	Centrality
1	Diagnosis related groups	358	0.03	11	Risk	108	0.04
2	Care	242	0.03	12	Health care	97	0.06
3	Outcome	208	0.04	13	Prevalence	78	0.05
4	Mortality	180	0.05	14	United States	72	0.05
5	Impact	165	0.08	15	Risk factors	68	0.06
6	Costs	158	0.06	16	Complications	65	0.03
7	Quality	125	0.04	17	Health	61	0.05
8	Surgery	124	0.04	18	Rates	55	0.04
9	Management	119	0.03	19	Trends	53	0.04
10	Length of stay	116	0.05	20	System	47	0.11

Figure 4 (A) The top 20 strongest strength citation burst; (B) Networks of keywords in the studies.

Table 5 Key Articles in Each Cluster

Cluster	Coverage	Title	First Author	Year
0	46	Impacts of a New Episode-Based Payment Scheme on Volume, Expenditures, and Efficiency in Public Hospitals: A Quasi-Experimental Interrupted Time-Series Study in Jinhua, China	Zhang T^Citation21	2022
1	41	2018 John Charnley Award: Analysis of US Hip Replacement Bundled Payments: Physician-initiated Episodes Outperform Hospital-initiated Episodes	Murphy WS^Citation22	2019
2	36	Do German DRGs appropriately explain the resource consumption of hospitals? An empirical patient-level cost-data analysis across ten episodes of care	Geissler A^Citation23	2014
3	29	Readmission Rates in the State of Florida: A Reflection of Quality?	Lavernia CJ^Citation24	2013
4	27	Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries	Quentin W^Citation25	2013
5	24	Effect Modification of Sex and Age for the Hospital Volume-Outcome Relationship in Abdominal Aortic Aneurysm Treatment: Secondary Data Analysis of the Nationwide German Diagnosis Related Groups Statistics From 2005 to 2014	Trenner M^Citation26	2020
6	23	Practicality of Acute and Transitional Care and its consequences in the era of SwissDRG: a focus group study	Wangmo T^Citation27	2019
7	22	The Cost of Hip and Knee Revision Arthroplasty by Diagnosis-Related Groups: Comparing Time-Driven Activity-Based Costing and Traditional Accounting	Fang CJ^Citation11	2021
8	20	Outcome, Use of Resources and Their Relationship in the Treatment of AMI, Stroke and Hip Fracture at European Hospitals	Hakkinen U^Citation28	2015
9	16	Breast cancer surgery and diagnosis-related groups (DRGs): Patient classification and hospital reimbursement in 11 European countries	Scheller-kreinsen D^Citation29	2013
10	15	Can case-based payment contain healthcare costs? - A curious case from China	Wu J^Citation30	2022

Figure 5 The cluster map of document co-citation.

Table 6 Top 10 Articles (Based on TGCS)

TGCS	First Author	Title	Year	Journal
269	Bezin J^Citation31	The national healthcare system claims databases in France, SNIIRAM and EGB: Powerful tools for pharmacoepidemiology	2017	Pharmacoepidemiology and Drug Safety
253	Gale SC^Citation35	The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample-2001 to 2010	2014	Journal of Trauma and Acute Care Surgery
218	Gialdini G^Citation36	Perioperative Atrial Fibrillation and the Long-term Risk of Ischemic Stroke	2014	Jama-journal of The American Medical Association
202	Fleischmann C^Citation34	Hospital Incidence and Mortality Rates of Sepsis An Analysis of Hospital Episode (DRG) Statistics in Germany From 2007 to 2013	2016	Deutsches Arzteblatt International
183	Cheung NH^Citation32	Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes	2014	Respiratory Care
181	Lee VS^Citation38	Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality	2016	Jama-Journal of the American Medical Association
149	Shepard J^Citation39	Financial Impact of Surgical Site Infections on Hospitals The Hospital Management Perspective	2013	Jama Surgery
133	Jayanna M^Citation37	Cost Analysis of Endoscopic Mucosal Resection vs Surgery for Large Laterally Spreading Colorectal Lesions	2016	Clinical Gastroenterology and Hepatology
132	Whitmore RG^Citation40	ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal costs	2014	Spine Journal
120	Dundon JM^Citation33	Improvement in Total Joint Replacement Quality Metrics Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative	2016	Journal of Bone and Joint Surgery-American Volume

Figure 6 Different classifications of DRGs.

Table 7 Advantages and Disadvantages of DRGs

Advantages	Disadvantages
Improve the quality and efficiency of medical services	Overtreatment by the health service
Reduce the waste of medical costs	Inadequate treatment of medical services
Promoting the rational allocation of medical resources	Leading to inequity in medical services
Control of medical costs and quality	Increased administrative costs for medical institutions
Assess hospital quality and efficiency	This caused dissatisfaction among the medical staff

Zhang T, Lu B, Yan Z, Huang X, Lu W. Impacts of a new episode-based payment scheme on volume, expenditures, and efficiency in public hospitals: a Quasi-experimental interrupted time-series study in Jinhua, China. Article. Risk Manag Healthc Policy. 2022;15:1659–1669. doi:10.2147/rmhp.S376516

 PubMed Web of Science ®Google Scholar

Murphy WS, Siddiqi A, Cheng T, et al. 2018 John Charnley Award: analysis of US hip replacement bundled payments: physician-initiated episodes outperform hospital-initiated episodes. Article; Proceedings paper. Clin Orthop Relat Res. 2019;477(2):271–280. doi:10.1097/corr.0000000000000532

 PubMed Web of Science ®Google Scholar

Geissler A, Quentin W, Busse R. Do German DRGs appropriately explain the resource consumption of hospitals? An empirical patient-level cost-data analysis across ten episodes of care. Article. Gesundheitswesen. 2014;76(5):284–296. doi:10.1055/s-0033-1351237

 PubMed Web of Science ®Google Scholar

Lavernia CJ, Villa JM, Iacobelli DA. Readmission rates in the state of Florida: a reflection of quality? Article. Clin Orthop Relat Res. 2013;471(12):3856–3862. doi:10.1007/s11999-013-2849-2

 PubMed Web of Science ®Google Scholar

Quentin W, Ratto H, Peltola M, Busse R, Hakkinen U; Euro DRGG. Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries. Article. Eur Heart J. 2013;34(26):1972–1981A. doi:10.1093/eurheartj/ehs482

 PubMed Web of Science ®Google Scholar

Trenner M, Salvermoser M, Busch A, Reutersberg B, Eckstein -H-H, Kuehnl A. Effect modification of sex and age for the hospital volume-outcome relationship in abdominal aortic aneurysm treatment: secondary data analysis of the Nationwide German Diagnosis Related Groups Statistics from 2005 to 2014. Article. J Am Heart Assoc. 2020;9(6):e014534. doi:10.1161/jaha.119.014534

 PubMed Web of Science ®Google Scholar

Wangmo T, Padrutt Y, Kone I, Gachter T, Elger BS, Leu A. Practicality of acute and transitional care and its consequences in the era of SwissDRG: a focus group study. Article. BMC Health Serv Res. 2019;19374. doi:10.1186/s12913-019-4220-0

 Google Scholar

Fang CJ, Shaker JM, Drew JM, Jawa A, Mattingly DA, Smith EL. The cost of hip and knee revision arthroplasty by diagnosis-related groups: comparing time-driven activity-based costing and traditional accounting. Article. J Arthroplasty. 2021;36(8):2674–2679. doi:10.1016/j.arth.2021.03.041

 PubMed Web of Science ®Google Scholar

Hakkinen U, Rosenqvist G, Iversen T, Rehnberg C, Seppala TT; Eurohope Study G. Outcome, use of resources and their relationship in the treatment of AMI, stroke and hip fracture at European hospitals. Article. Health Econ. 2015;24:116–139. doi:10.1002/hec.3270

 PubMed Web of Science ®Google Scholar

Scheller-Kreinsen D, Quentin W, Geissler A, Busse R; Euro DRGG. Breast cancer surgery and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries. Article. Breast. 2013;22(5):723–732. doi:10.1016/j.breast.2012.11.001

 PubMed Web of Science ®Google Scholar

Wu J, He X, Feng XL. Can case-based payment contain healthcare costs? - A curious case from China. Article. Soc Sci Med. 2022;312115384. doi:10.1016/j.socscimed.2022.115384

 Web of Science ®Google Scholar

Bezin J, Duong M, Lassalle R, et al. The national healthcare system claims databases in France, SNIIRAM and EGB: powerful tools for pharmacoepidemiology. Article. Pharmacoepidemiol Drug Saf. 2017;26(8):954–962. doi:10.1002/pds.4233

 PubMed Web of Science ®Google Scholar

Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: a 10-year analysis of the Nationwide Inpatient Sample-2001 to 2010. Article. J Trauma Acute Care Surg. 2014;77(2):202–208. doi:10.1097/ta.0000000000000362

 PubMed Web of Science ®Google Scholar

Gialdini G, Nearing K, Bhave PD, et al. Perioperative atrial fibrillation and the long-term risk of ischemic stroke. Article. JAMA. 2014;312(6):616–622. doi:10.1001/jama.2014.9143

 PubMed Web of Science ®Google Scholar

Fleischmann C, Thomas-Rueddel DO, Hartmann M, et al. Hospital incidence and mortality rates of sepsis an analysis of hospital episode (DRG) statistics in Germany From 2007 to 2013. Article. Dtsch Arztebl Int. 2016;113(10):159–166. doi:10.3238/arztebl.2016.0159

 PubMed Web of Science ®Google Scholar

Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Article. Respir Care. 2014;59(6):895–915. doi:10.4187/respcare.02971

 PubMed Web of Science ®Google Scholar

Lee VS, Kawamoto K, Hess R, et al. Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. Article. JAMA. 2016;316(10):1061–1072. doi:10.1001/jama.2016.12226

 PubMed Web of Science ®Google Scholar

Shepard J, Ward W, Milstone A, et al. Financial impact of surgical site infections on hospitals the hospital management perspective. Article. JAMA Surg. 2013;148(10):907–914. doi:10.1001/jamasurg.2013.2246

 PubMed Web of Science ®Google Scholar

Jayanna M, Burgess NG, Singh R, et al. Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions. Article. Clin Gastroenterol Hepatol. 2016;14(2):271–278. doi:10.1016/j.cgh.2015.08.037

 PubMed Web of Science ®Google Scholar

Whitmore RG, Stephen JH, Vernick C, et al. ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal costs. Article. Spine J. 2014;14(1):31–38. doi:10.1016/j.spinee.2013.03.011

 PubMed Web of Science ®Google Scholar

Dundon JM, Bosco J, Slover J, Yu S, Sayeed Y, Iorio R. Improvement in total joint replacement quality metrics year one versus year three of the bundled payments for care improvement initiative. Article. J Bone Joint Surg. 2016;98(23):1949–1953. doi:10.2106/jbjs.16.00523

 PubMed Web of Science ®Google Scholar