{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:47:08Z","timestamp":1792068428713,"version":"4.4.0"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HIM J"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Accurate medical record front-page (discharge summary face sheet) documentation supports diagnosis-related group (DRG) classification and payment review. Evidence on disease-specific management for diabetic nephropathy (DN) remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate associations of refined front-page management with complication coding patterns, length of stay, total hospitalisation cost and cost structure in adults admitted principally for DN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>We retrospectively compared 48 index hospitalisation episodes in 2023 with 85 episodes from January 2025 to February 2026 at Peking University First Hospital Linquan Hospital. Both periods used the International Classification of Diseases, Tenth Revision, National Clinical Edition 2.0 diagnosis dictionary and China Healthcare Security Diagnosis Related Groups 1.1 framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Drug cost proportion decreased from 26.7% to 16.1% (difference, \u221210.6\u2009percentage points; 95% confidence interval (CI), \u221215.0 to \u22126.2; standardised mean difference (SMD), \u22120.97;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), while medical service fee proportion increased from 17.9% to 21.3% (difference, 3.4\u2009percentage points; 95% CI, 1.5\u20135.3; SMD, 0.60;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.001). Total costs were unchanged (median (interquartile range), 3508.56 (2940.07\u20134186.97) vs. 3475.42 (2902.41\u20134161.56) RMB;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.850). Coding with E11.700 (Type 2 diabetes mellitus with multiple complications) or E11.700x033 (Type 2 diabetes mellitus with multiple complications, diabetic nephropathy) increased from 0.0% to 52.9% (risk difference, 52.9\u2009percentage points; 95% CI, 40.1\u201363.2; Cramer\u2019s\n                      <jats:italic toggle=\"yes\">V<\/jats:italic>\n                      \u2009=\u20090.54;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), compared with E11.201\u2009+\u2009N08.3* (Type 2 diabetes mellitus with diabetic nephropathy; N08.3*, glomerular disorders in diabetes mellitus).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Refined front-page management was associated with more service-oriented costs and more complete capture of documented complications, without higher total costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for health information management practice:<\/jats:title>\n                    <jats:p>Disease-specific checklists and coder-physician review may strengthen payment-related data quality under DRG reimbursement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/18333583261490625","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:03:16Z","timestamp":1791795796000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis-related group front-page management, coding patterns and cost structure in diabetic nephropathy"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1346-0102","authenticated-orcid":false,"given":"Hongfei","family":"Li","sequence":"first","affiliation":[{"name":"Peking University First Hospital, Linquan Hospital, Fuyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_3_4_2_1","doi-asserted-by":"crossref","unstructured":"Bao C Liu H (2026) A historical perspective of the development of public hospitals in China (1949\u20132024). Critical Public Health 36(1): 2606502. https:\/\/doi.org\/10.1080\/09581596.2025.2606502","DOI":"10.1080\/09581596.2025.2606502"},{"key":"e_1_3_4_3_1","doi-asserted-by":"crossref","unstructured":"Cao Z Liu X Wang X et al. (2024) Impacts of DRG-based prepayment reform on the cost and quality of patients with neurologic disorders: Evidence from a quasi-experimental analysis in Beijing China. Risk Management and Healthcare Policy 17: 1547\u20131560. https:\/\/doi.org\/10.2147\/RMHP.S458005","DOI":"10.2147\/RMHP.S458005"},{"key":"e_1_3_4_4_1","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J","year":"1988","unstructured":"Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates.","edition":"2"},{"key":"e_1_3_4_5_1","doi-asserted-by":"crossref","unstructured":"Du L Fang S Zhang Q (2025) Trend analysis of medical expenses under DRG payment reform in China. Scientific Reports 15(1): 36961. https:\/\/doi.org\/10.1038\/s41598-025-20902-0","DOI":"10.1038\/s41598-025-20902-0"},{"key":"e_1_3_4_6_1","doi-asserted-by":"crossref","unstructured":"Farber JI Holcombe RF (2014) Clinical documentation improvement as a quality metric in oncology. Journal of Clinical Oncology 32(30): 123. https:\/\/doi.org\/10.1200\/jco.2014.32.30_suppl.123","DOI":"10.1200\/jco.2014.32.30_suppl.123"},{"key":"e_1_3_4_7_1","doi-asserted-by":"crossref","unstructured":"Feng X Cheng L Wei H (2024) Study on the cost-control effect of diagnosis-related groups based on meta-analysis. Medicine 103(37): e39421. https:\/\/doi.org\/10.1097\/MD.0000000000039421","DOI":"10.1097\/MD.0000000000039421"},{"key":"e_1_3_4_8_1","doi-asserted-by":"crossref","unstructured":"Fisher RA (1922) On the interpretation of chi-square from contingency tables and the calculation of P. Journal of the Royal Statistical Society 85(1): 87\u201394. https:\/\/doi.org\/10.2307\/2340521","DOI":"10.2307\/2340521"},{"key":"e_1_3_4_9_1","doi-asserted-by":"crossref","unstructured":"Fu Y Gao G Xing H et al. (2025) Research on the primary factors influencing the quality of clinical coding under DRG payment systems: A survey research. Healthcare 13(8): 849. https:\/\/doi.org\/10.3390\/healthcare13080849","DOI":"10.3390\/healthcare13080849"},{"key":"e_1_3_4_10_1","first-page":"912","article-title":"Accuracy and completeness of clinical coding using ICD-10 for ambulatory visits","volume":"2017","author":"Horsky J","year":"2018","unstructured":"Horsky J, Drucker EA, Ramelson HZ (2018) Accuracy and completeness of clinical coding using ICD-10 for ambulatory visits. AMIA Annual Symposium Proceedings 2017: 912\u2013920.","journal-title":"AMIA Annual Symposium Proceedings"},{"key":"e_1_3_4_11_1","doi-asserted-by":"crossref","unstructured":"Hu H Sawhney M Shi L et al. (2015) A systematic review of the direct economic burden of type 2 diabetes in China. Diabetes Therapy 6(1): 7\u201316. https:\/\/doi.org\/10.1007\/s13300-015-0096-0","DOI":"10.1007\/s13300-015-0096-0"},{"key":"e_1_3_4_12_1","doi-asserted-by":"crossref","unstructured":"Li X Xu Z Ji L et al. (2019) Direct medical costs for patients with type 2 diabetes in 16 tertiary hospitals in urban China: A multicentre prospective cohort study. Journal of Diabetes Investigation 10(2): 539\u2013551. https:\/\/doi.org\/10.1111\/jdi.12905","DOI":"10.1111\/jdi.12905"},{"key":"e_1_3_4_13_1","doi-asserted-by":"crossref","unstructured":"Liu Y Liao Z Tan J et al. (2025) Impact of DRG policy on the performance of tertiary hospital inpatient services in Chongqing China: An interrupted time series study 2020\u20132023. Frontiers in Public Health 13: 1523067. https:\/\/doi.org\/10.3389\/fpubh.2025.1523067","DOI":"10.3389\/fpubh.2025.1523067"},{"key":"e_1_3_4_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-024-02750-6"},{"key":"e_1_3_4_15_1","doi-asserted-by":"crossref","unstructured":"Luo M Li H Li R et al. (2025) The impact of DRG payment reform on inpatient costs for different surgery types: An empirical analysis based on Chinese tertiary hospitals. Frontiers in Public Health 13: 1563204. https:\/\/doi.org\/10.3389\/fpubh.2025.1563204","DOI":"10.3389\/fpubh.2025.1563204"},{"key":"e_1_3_4_16_1","doi-asserted-by":"publisher","DOI":"10.1214\/aoms\/1177730491"},{"key":"e_1_3_4_17_1","doi-asserted-by":"crossref","unstructured":"Meng ZL Hui W Cai YY et al. (2020) The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis. Health Policy 124(4): 359\u2013367. https:\/\/doi.org\/10.1016\/j.healthpol.2020.01.007","DOI":"10.1016\/j.healthpol.2020.01.007"},{"key":"e_1_3_4_18_1","volume-title":"Evaluation Standards for Tertiary General Hospitals","author":"National Health Commission","year":"2022","unstructured":"National Health Commission (2022) Evaluation Standards for Tertiary General Hospitals, 2022 edn. National Health Commission."},{"key":"e_1_3_4_19_1","volume-title":"Three-Year Action Plan for Healthcare Payment Reform Based on DRG\/DIP","author":"National Healthcare Security Administration of China","year":"2021","unstructured":"National Healthcare Security Administration of China (2021) Three-Year Action Plan for Healthcare Payment Reform Based on DRG\/DIP. National Healthcare Security Administration of China."},{"key":"e_1_3_4_20_1","doi-asserted-by":"crossref","unstructured":"Shapiro SS Wilk MB (1965) An analysis of variance test for normality (complete samples). Biometrika 52(3\u20134): 591\u2013611. https:\/\/doi.org\/10.2307\/2333709","DOI":"10.1093\/biomet\/52.3-4.591"},{"key":"e_1_3_4_21_1","unstructured":"Yunting C Mu HU Chenggang JIN (2024) The impact of the DRG payment system on the high-quality development of public hospitals. Medical Journal of Peking Union Medical College Hospital 15(5): 987\u2013992. https:\/\/doi.org\/10.12290\/xhyxzz.2024-0667"},{"key":"e_1_3_4_22_1","doi-asserted-by":"crossref","unstructured":"Zhang Q Li X (2022) Application of DRGs in hospital medical record management and its impact on service quality. International Journal for Quality in Health Care 34(4): mzac090. https:\/\/doi.org\/10.1093\/intqhc\/mzac090","DOI":"10.1093\/intqhc\/mzac090"},{"issue":"2","key":"e_1_3_4_23_1","article-title":"Assessing ICD data quality and its impact on DRG payments: Evidence from a women and children special hospital in China","volume":"21","author":"Zhang Y","year":"2024","unstructured":"Zhang Y, Dong H, Xu SY, et al. (2024) Assessing ICD data quality and its impact on DRG payments: Evidence from a women and children special hospital in China. Perspectives in Health Information Management 21(2): 1b.","journal-title":"Perspectives in Health Information Management"},{"key":"e_1_3_4_24_1","doi-asserted-by":"crossref","unstructured":"Zhu T Chen C Zhang X et al. (2024) Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group. BMJ Open 14: e073913. https:\/\/doi.org\/10.1136\/bmjopen-2023-073913","DOI":"10.1136\/bmjopen-2023-073913"}],"container-title":["Health Information Management Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/18333583261490625","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/18333583261490625","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/18333583261490625","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:49:26Z","timestamp":1792064966000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/18333583261490625"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":23,"alternative-id":["10.1177\/18333583261490625"],"URL":"https:\/\/doi.org\/10.1177\/18333583261490625","relation":{},"ISSN":["1833-3583","1833-3575"],"issn-type":[{"value":"1833-3583","type":"print"},{"value":"1833-3575","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"article-number":"18333583261490625"}}