Unplanned readmission within 31 days of discharge after stroke is a useful indicator for monitoring quality of hospital care. We evaluated the risk factors associated with 31-day unplanned readmission of stroke patients in China. We identified 50,912 patients from 375 hospitals in 29 provinces, municipalities or autonomous districts across China who experienced an unplanned readmission after stroke between 2015 and 2016, and extracted data from the inpatients’ cover sheet data from the Medical Record Monitoring Database. Patients were grouped into readmission within 31 days or beyond for analysis. Chi-squared test was used to analyze demographic information, health system and clinical process-related factors according to the data type. Multilevel logistic modeling was used to examine the effects of patient (level 1) and hospital (level 2) characteristics on an unplanned readmission ≤31 days. Among 50,912 patients, 14,664 (28.8%) were readmitted within 31 days after discharge. The commonest cause of readmissions were recurrent stroke (34.8%), hypertension (22.94%), cardio/cerebrovascular disease (13.26%) and diabetes/diabetic complications (7.34%). Higher risks of unplanned readmissions were associated with diabetes (OR = 1.089, P = 0.001), use of clinical pathways (OR = 1.174, P < 0.001), and being discharged without doctor’s advice (OR = 1.485, P < 0.001). Lower risks were associated with basic medical insurances (OR ranging from 0.225 to 0.716, P < 0.001) and commercial medical insurance (OR = 0.636, P = 0.021), compared to self-paying for medical services. And patients aged 50 years old and above (OR ranging from 0.650 to 0.985, P < 0.05), with haemorrhagic stroke (OR = 0.467, P < 0.001), with length of stay more than 7 days in hospital (OR ranging from 0.082 to 0.566, P < 0.001), also had lower risks. Age, type of stroke, medical insurance status, type of discharge, use of clinical pathways, length of hospital stay and comorbidities were the most influential factors for readmission within 31 days.

Introduction: Given the ongoing development and significant medical role of Traditional Medicine Hospital (TCM) techniques in Chinese TCM hospitals, it is imperative to conduct an assessment on the influence of the gradual implementation of the DRG reimbursement system in W City's three public hospitals on the utilization of appropriate techniques of TCM.Methods: This study uses the Difference-in-Difference method to analyze the economic impact of the DRG reimbursement system. It compares cost changes between the TCM techniques group and other groups before and after DRG implementation to reveal the actual influence on cost. Visualization tools show cost variations from 2019 to 2022, bolstering research credibility. A T-test analyzes cost disparities, validating prediction model accuracy. Finally, a parallel trend test ensures reliability of the DID model's results.Results: (1)The total cost of appropriate techniques of TCM group decreased significantly (p < 0.001), with a 14.27% reduction in cost-effective TCM techniques (p < 0.001) but no significant changes in surgical cost.(2) Cost analysis of various TCM techniques showed significant decreases in total cost for external treatment and acupuncture, by 4.78% and 8.06% respectively (p < 0.001). cost for external treatment, orthopedic treatment, acupuncture, and special therapies also decreased by 13.67%, 14.27%, 16.8%, and 9.3% respectively (p < 0.001).(3)After analyzing 8 departments with high discharge rates, the total cost of TCM techniques in cardiology decreased by 18.86% (p < 0.001) under the DRG reimbursement system, while acupuncture cost increased by 11.85% (p < 0.001). In orthopedics, TCM techniques cost decreased by 30.3% (p < 0.001), but acupuncture and stomach/spleen departments saw significant increases of 18.88% and 46.66% respectively (p < 0.001).(4)Overall, there has been a significant reduction in the cost of TCM techniques following DRG payment reform. Notably, cost changes varied across departments, and acupuncture and moxibustion have experienced substantial cost fluctuations.Conclusions: The DRG payment reform has had a significant impact on appropriate techniques of TCM utilization and medical expense control, reflecting hospitals’ strategic adjustment in balancing service quality with the DRG policy. It is recommended that policymakers consider the compatibility of DRG with TCM methods to ensure fairness and efficiency.

With rising healthcare costs, controlling expenses while improving service quality is crucial in global healthcare reform. The C-DRG medical insurance paym