The DEMATEL method explores the interdependent relationship structure and weights for diagnosis-related groups system

Abstract

Purpose: This study constructs a structure of interaction between dimensions and criteria within the diagnosis-related groups (DRGs) system from a quantitative system and identifies key factors affecting the overall performance of medical services.

Method: From September to December 2020, the influence relation structure diagram (IRSD) of the dimensions and corresponding criteria was developed from the practical experience of a group of domain experts, based on the DEMATEL method. Subsequently, all dimensions and criteria construct influential weights from a systems perspective. Finally, the main influential factors were identified based on the analysis results.

Results: The IRSD results showed that, in the overall performance of medical services, "Medical service capacity (C ₁)" was the main influential dimension, influencing both "Medical service efficiency (C ₂)" and "Medical service safety (C ₃)." At the criteria level, "Case-mix index (CMI) (C ₁₂)," "Time efficiency index (C₂₁)," and "Inpatient mortality of medium-to-low group (C₃₂)" were the main influential criteria in the corresponding dimensions. The influential weight results showed that "Medical service capacity (C ₁)" was also a key dimension. "Case-mix index (CMI) (C ₁₂)," "Cost efficiency index (C ₂₂)," and "Inpatient mortality of medium-to-low group (C ₃₂)" were the key criteria in their respective dimensions.

Conclusion: Patients and managers should first focus on the capacity of medical service providers when making a choice or deciding using the results of the DRGs system. Furthermore, they should pay more attention to medical safety even if it is not as weighted as medical efficiency.

Keywords: decision-making trial and evaluation laboratory (DEMATEL); diagnosis-related groups (DRGs); key factors; multiple criteria decision-making (MCDM); the interdependent relationship structure and weights.