Construction of Hospital Diagnosis-Related Group Refinement Performance Evaluation Based on Delphi Method and Analytic Hierarchy Process

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Please make sure to provide strengths and limitations to the study, especially since it was completed in one region

Very well written.  watch spacing.  Figures need to be larger to view wording.  See document attached.

 

Comments for author File: Comments.pdf

Author Response

Thank you for your meticulous review, which significantly strengthened our work.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

in special mail

Comments for author File: Comments.pdf

Comments on the Quality of English Language

would be good to show the text to native speakerse

Author Response

Thank you for your meticulous review, which significantly strengthened our work.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The originality of this study lies in several key aspects:

1. Context-Specific Index Development:

It is tailored specifically for district-level public hospitals in Chongqing, a setting that is often underrepresented in performance evaluation research, especially compared to tertiary or national hospitals. This local focus fills a gap in performance management tools for lower-tier hospitals in China’s healthcare system.

2. Integration of DRG with AHP and Delphi Methods:

While DRG-based performance evaluation is not new, combining it with both the Delphi methodfor expert consensus and AHP for indicator weighting adds methodological originality. This structured multi-method approach ensures both relevance and scientific rigor in the construction of the index system.

3. Comprehensive, Multidimensional Indicator Set:

The inclusion of indicators like the Low-Risk Group Mortality Rate, Cost Consumption Index, and proportion of complex surgeries reflects a balanced focus on quality, efficiency, and complexity of care. This comprehensive design enhances its usefulness as a benchmarking tool.

4. Practical Validation Through Real-World Data:

The application of the index to real 2020 hospital data, showing measurable improvements, demonstrates practical value and effectiveness—making it not just theoretical, but implementable.

 

Overall, the work is original in how it contextualizes international evaluation frameworks (like DRG) to a localized Chinese healthcare setting, using a rigorous, multi-method approach to create a tailored, actionable performance tool.

 

While the study makes a significant contribution to developing a DRG-based performance evaluation index system for district-level public hospitals in China, several potential shortcomings can be identified:

1. Limited Generalizability:

The system was developed based on data from a single district-level hospital in Chongqing. Hospital characteristics, patient demographics, and regional healthcare policies may differ across China, limiting the applicability of the results to other settings without adjustments.

2. Retrospective Design and Time Constraint:

The performance improvements were evaluated using data from only one year (2020). This short time frame does not allow for robust trend analysis or assessment of long-term effectiveness.

3. Lack of External Validation:

There is no mention of validating the index system in other hospitals or settings, which would be necessary to confirm its reliability and usefulness across institutions.

 

4.Incomplete Coverage of Hospital Functions:

The index system appears focused primarily on inpatient performance and financial indicators. It may overlook important aspects such as outpatient care, patient satisfaction, staff performance, or community health impact.

5.Limited Patient-Centered Metrics:

Indicators such as patient-reported outcomes, experience, and satisfaction are not included, which are increasingly recognized as essential components of healthcare quality.

 

Comments on the Quality of English Language

Acceptable

Author Response

Thank you for your meticulous review, which significantly strengthened our work.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Dear Authors,

First of all, I would like to congratulate you on your article entitled “Construction of Hospital DRG Refinement Performance Evaluation based on Delphi Method and Analytic Hierarchy Process (AHP)”, which presents a thoughtful and methodologically sound approach to building a performance evaluation system tailored for district-level public hospitals in China.

The integration of the Delphi method and AHP is appropriate and effectively executed. The structure of the indicators and the visual representations demonstrate a serious effort to translate hospital performance complexity into measurable criteria. However, I would like to offer some constructive suggestions to improve the work for future revisions or applications:

1. Additional statistical analysis: While the weighting process is well-described, the study could be enhanced by including confidence intervals, normality testing, or a sensitivity analysis of the weights assigned through AHP. These steps would strengthen the reliability of your results.
2. More in-depth figure interpretation: Especially in Figures 3 and 4, a more detailed discussion of the scatter plot quadrants would be beneficial. Identifying departments that fall into risk zones (e.g., low CMI with high cost or time) and discussing possible managerial strategies could add significant value.
3. Clarification of study limitations:A more explicit section on methodological limitations would be helpful—for instance, addressing potential bias in expert selection or limits to generalizability across different hospital contexts.
4. International comparison:A brief comparison with similar international DRG-based performance frameworks, even from larger hospitals, would enrich the scientific positioning of your study.
5. Patient involvement and satisfaction:Although patient satisfaction is mentioned as an indicator, there is little information on how this data was collected or analyzed. Further elaboration or justification would improve this aspect of the study.

Again, congratulations on this important and relevant research. I hope these suggestions help strengthen the impact and clarity of your work.

Comments for author File: Comments.pdf

Author Response

Thank you for your meticulous review, which significantly strengthened our work.

Author Response File: Author Response.pdf

Reviewer 5 Report

Comments and Suggestions for Authors

First of all, the title is not clear at all. It includes two acronyms (DRG and AHP) and one of them is not even explicit. The same lack of clarity should be improved throughout all the article. Figure 1 is not readable. Figure 4 is completely unreadable. Figures 3 is also not readable and Figure 4 offers space for increasing clarity. Then, tables and figures are seen as underdeveloped or unclear.

The introduction could better differentiate between performance measurement and performance management as conceptual frameworks. There is limited international context; the article would benefit from referencing more global studies for comparison. To solve the lack of theoretical grounding, the article should embed the analysis more explicitly in performance management theory.

It’s not always clear how generalizable the findings are outside of the Chongqing setting. A stronger justification for using Delphi and AHP vs. other multi-criteria methods, could also be included. Similarly, results are focused mostly on internal improvements; no benchmarks or comparisons to other hospitals are provided.

The phrasing or the article is confusing, and should be interesting to perform a thorough language revision or a professional proofreading.

Author Response

Thank you for your meticulous review, which significantly strengthened our work.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

No major concerns 

Author Response

Dear Professor ,

Thank you for your invaluable time and expertise in reviewing our manuscript titled "Construction of Hospital DRG Refinement Performance Evaluation Based on Delphi Method and Analytic Hierarchy Process" (Manuscript ID: [hospitals-3530651]). We are deeply honored by your final assessment confirming that no further revisions are required.

Your rigorous critique throughout the review process has been instrumental in strengthening this work.

We have formally acknowledged your contribution in the Acknowledgments section:

"We extend profound gratitude to the anonymous reviewers for their transformative feedback that significantly enhanced this work’s scientific and policy value."

Upon publication, we will share the final formatted paper via email.

Next Steps & Open Offer

The editorial office has been notified of your completion notice.

Should you wish to explore collaboration on related topics (e.g., multi-region DRG validation), we welcome the opportunity to connect.

Reviewer 5 Report

Comments and Suggestions for Authors

Thank you for your thoughtful revisions, since they update the article. While external benchmarking is still absent in the results, your recognition of this it is a way for future work. No further revisions are requested from my side.

Author Response

Dear Professor ,

Thank you for your invaluable time and expertise in reviewing our manuscript titled "Construction of Hospital DRG Refinement Performance Evaluation Based on Delphi Method and Analytic Hierarchy Process" (Manuscript ID: [hospitals-3530651]).We are deeply honored by your final assessment confirming that minor revisions are required.

Response to Reviewer Comments

Comment: "Minor revisions are recommended to improve the clarity of presentation, better frame the limitations, and tighten some of the interpretative sections."

Response:
We sincerely appreciate these constructive suggestions. The following revisions have been implemented to enhance scholarly rigor and accessibility:

• Added to Methods (Lines 169-170):

  "Two-round Delphi consensus achieved 100% response rate (28/28), with pre-defined inclusion criteria: >70% agreement per indicator."