literature review knowledge management

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• Med J Islam Repub Iran

The current understanding of knowledge management concepts: A critical review

Shahram yazdani.

1 Virtual school of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Snor Bayazidi

Amir ali mafi.

2 Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Background: Higher education institutions include experts who are knowledgeable. Knowledge management facilitates institutions to enhance the capacity to collect information and knowledge and apply it to problem-solving and decision making. Through the review of related studies, we observed that there are multiple concepts and terms in the field of knowledge management. Thus, the complexity and variety of these concepts and definitions must be clarified. Considering the importance of clarifying these concepts for utilization by users, this study aimed to examine the concepts related to this filed.

Methods: The methodology used in this study was based on the Carnwell and Daly's critical review method. An extensive search was carried out on various databases and libraries. A critical and profound review was carried out on selected articles. Many wandering concepts were found. Identified concepts were classified into seven categories based on conceptual proximity. Existing definitions and evidence in relation to extracted concepts were criticized and synthesized. The definitional attributes for them were identified and a conceptual identity card was provided for each of the concepts.

Results: Thirty-seven concepts with the most relevance to the field of knowledge management were extracted. There was no clear boundary among them, and they wandered. To avoid more confusion, concepts were classified according to semantic relation. Eight categories were created; each category consisted of a mother concept and several other concepts with similarity and proximity to the meaning of the original concept. Their attributes have been identified, and finally, each of them was presented in the form of a conceptual identity card.

Conclusion: Through critically reviewing the literature in this field, we were able to identify the concepts and realize their attributes. In this way, we came to a new interpretation of the concepts. At the end of the study, we concluded that some of the concepts have not been properly defined and are not properly located in the knowledge management field; also their application is uncertain.

↑ What is “already known” in this topic:

There are numerous and complex concepts in the field of knowledge management that have not been clarified, and most of them are used incorrectly. For example, in many studies, the concept of knowledge management and knowledge translation are used interchangeably, and there is no distinct boundary among concepts.

→ What this article adds:

The identified concepts were wandering. To avoid more confusion, concepts were classified according to semantic relation. Eight categories were created, including a sentinel concept and several other neighbor concepts. Their attributes have been identified, and finally, each of them was presented in the form of a conceptual identity card.

Introduction

The organization in the age of knowledge is an organization that is based on the best available knowledge and information. To succeed in today's challenging organizational environment, organizations need to learn from past mistakes rather than repeating those mistakes. This process occurs through knowledge management ( 1 , 2 ). Knowledge management (KM) is important, especially for organizations that their successes depend on the production, use, and integration of knowledge by professionals and employees. Higher education institutions are made up of experts who are knowledgeable. KM is a new field in the academic environment, and many universities are actively involved in related activities in this field ( 3 ). Conferences and seminars are taking place at the national and international levels in this regard. In the field of education, due to the need to explore the power and intellectual capital available to share experiences, this area has been very much considered ( 4 ). All knowledge production organizations such as research, development centers and higher education institutions from colleges to universities are looking for new concepts in their favorite subject. They also help create knowledge through various programs, considered as "knowledge houses" ( 5 ). So, the knowledge of the professors flows to the students and new knowledge is produced. Information is created in various forms and sources such as books, articles, dissertations, reports, and more. Knowledge management helps these institutions to enhance the capacity to collect information and knowledge and apply it to problem-solving and decision making ( 6 ). Therefore, evidence shows that any academic institution is associated with knowledge. In these institutions, the information and knowledge gained in the scientific community's core area should be disseminated for further growth ( 5 ). But, there are challenges in this direction. Studies have demonstrated that knowledge created in educational institutions is not properly stored and obtained. Most of the time, knowledge created in that system remains unknown and is considered as gray literature ( 6 ). The academic environment is considered as the knowledge houses, but if the generated knowledge in that organization is not properly organized, it will minimize its usefulness and leads to repeat activities ( 7 ). Despite the importance of knowledge management for educational systems, there is still no awareness about its development by academics. There is a need to create a culture of sharing knowledge among professors, staff and students who are still afraid of losing their knowledge through exchange and dissemination ( 8 ). The use of information communication technology and the development of advanced skills in the training of professions for the purpose of participation, communication, acquisition, recording and dissemination of knowledge are used very poorly in universities. Therefore, they need to adopt a policy in this regard ( 7 ). New educational systems are market-oriented and are becoming entrepreneurs. They should be accountable to the academic governance system. Therefore, educational institutions and academics faced with global pressures, research, and interdisciplinary subjects. In the complexity of such as global education market, there is a need for a motivating environment ( 6 ).

We mentioned the importance of knowledge management in the educational system, as well as the existence of challenges in this direction, but although much research has been done in this regard, knowledge workers, those who are willing to do research or scientific activity in this area face difficulties. The main reason for this problem is that there are numerous and complex concepts in this area that have not been clarified, and most of them are used incorrectly. For example, in many studies and even by academics, the concept of knowledge management and knowledge translation are used interchangeably, and there is no distinct boundary among concepts. On the other hand, despite the multiplicity of concepts in this field, the research that has examined all of these concepts together has not been found. Considering the importance of clarifying these concepts for utilization by users, the first step in this direction is to identify and clarify concepts associated with knowledge management. Therefore, in this study, we intend to examine the concepts and definitions related to them through a critical review method, accordingly identify their attributes, and based on the identified attributes, concepts become clear.

The result of this study can help managers, policymakers, professors, students, and researchers who after us, intend to carry out research related to the field of knowledge management.

Our methodology was based on the critical review of the literature introduced by Carnwell and Daly. The following five steps were performed; 1- detremination the scope of the review, 2- identification relevant information resources, 3-literature review, 4-writing the review,5- application of the review results in the study ( 9 ).

The review scoop was theoretical research published in the research journals. An extensive search was carried out on various databases (google scholar, PubMed, Embase, Elsevier, Scopus, Iran Medex, SID, and online libraries and dictionaries). The main keywords in the search were: knowledge management concepts, knowledge management stages, knowledge management implementation, knowledge management in higher education, and knowledge management in medical education. As a result, numerous articles were found. To restrict the search results, we set the inclusion criteria and exclusion criteria. Inclusion criteria were the studies and books related to knowledge management concepts without time limitation. Non-academic research was the exclusion criteria. The articles were examined superficially. Then the primary screening was done on the titles. So, a summary of the articles was studied and those articles that were most closely related to the concepts of knowledge management were selected to study the full text. Priority in reading was based on their relevance to study objectives and literature with more conceptual richness. A critical review was carried on publications with the purpose of clarifying the boundary among concepts. Thirty-seven concepts that were involved in the KM process were extracted. Since there were many wandering concepts in this path, in order to avoid confusion, they were examined based on semantic proximity in separate categories. Each category included a mother concept and other related concepts to it. Then by synthesizing existing definitions and evidence about each of the concepts, we tried to identify the characteristics on which they are defined. Ultimately each of the concepts was presented in the new classification based on these characteristics.

There were many wandering concepts in the field of knowledge management, in order to avoid bewilderment; concepts were examined based on semantic proximity in separate categories. Each category included a mother concept with related concepts to it. By critique and comparing the definitions and evidence about each of the concepts, their attributes were identified. Finally, based on these features, a conceptual identity card for each concept was presented. Our result presented in nine categories: knowledge Generation (knowledge acquisition, knowledge selection, knowledge building, knowledge creation, knowledge capture), Knowledge processing( knowledge synthesis, knowledge integration, knowledge refinement, knowledge tailoring, knowledge customization)knowledge storage (knowledge assimilation, knowledge package, knowledge documentation, knowledge indexing), Knowledge transfer( knowledge sharing, knowledge exchange, knowledge dissemination, knowledge publication), Knowledge capitalization( knowledge commercialization, knowledge valorization), Knowledge brokering, Knowledge utilization(, knowledge adoption, knowledge adaptation, knowledge reuse), Knowledge translation, and Knowledge management.

In the following, the conceptual identity of each of the concepts, which includes the specific features about that concept, is introduced.

Knowledge Generation : Knowledge acquisition, knowledge capture, knowledge selection, knowledge creation, knowledge building.

Knowledge acquisition attributes

Purpose: The purpose of knowledge acquisition is to enhance the organizations' competitive edge through increasing an organization’s operational knowledge base ( 10 ).

Source of obtaining knowledge: The source of obtaining knowledge is internal and external sources ( 10 ).

Type of acquired Knowledge: Type of acquired knowledge can be either tacit or explicit ( 10 ).

Activities: Activities related to knowledge acquisition are identification of knowledge, obtaining the identified knowledge, transferring the knowledge for immediately using or internalization ( 11 ).

Key point: Knowledge acquired can either be tacit or explicit but must add value to the organization ( 10 ).

Knowledge selection attributes

Purpose: The purpose of knowledge selection is Identification the knowledge according to organizational needs in internal sources, Provide knowledge at the appropriate place and by the appropriate form ( 12 ).

Source of obtaining knowledge: Knowledge is obtained from internal sources ( 12 ).

Activities: Knowledge selection activities include the following: identification of knowledge from internal sources, obtaining the identified knowledge from internal sources, transfer the knowledge for immediately using or internalization ( 12 )

Key point: Knowledge selection is the opposite point of knowledge acquisition ( 12 ).

Knowledge capturing attributes

Purpose: The purpose of knowledge capture is to maintain knowledge in order to organizational performance improvement, ensure that knowledge available is stored for future reference ( 13 ).

Form: Knowledge captured in the form of databases or manuals ( 13 ).

Knowledge creation attributes

Context: Knowledge creation occurs through the inference or discovery from knowledge sources ( 12 ).

Purpose: Creating or producing knowledge helps organizations gain a competitive advantage by providing valuable, rare, and inimitable resources ( 14 ). Utilization of complex and discontinuous events and phenomena to Confronting recognized organizational problems ( 15 ).

Activities: Knowledge selection activities include the following: control the organizational knowledge, Control the external environment, Creation knowledge from the existing basic knowledge, Transfer created knowledge for externalization or internalization ( 12 ).

Knowledge creation place: Knowledge is produced in the Research community, Professional Councils, Ministries and governmental organizational, Transfer and innovation centers, Science communities ( 16 ).

Form: Some scientists have defined knowledge creation as a process, output, and outcome ( 15 , 17 ).

Knowl edge building attributes

Context: The term knowledge building first appeared in the learning sciences literature ( 18 ).

Purpose: The purpose of knowledge creation is the creation or modification of public knowledge—knowledge that lives ‘in the world’ and is available to be worked on and used by other people. These pursuits should advance the current understanding of individuals within a group, at a level beyond their initial knowledge level, and should be directed towards advancing the understanding of what is known about that topic or idea ( 19 ).

Steps: Knowledge building consists of the following steps: creation, testing, and improvement of conceptual artifacts ( 19 ).

Requirements: It encompasses the foundational learning, sub-skills, and socio-cognitive dynamics pursued in other approaches, along with the additional benefit of movement along the trajectory to mature education ( 20 ).

Path: Knowledge building can be considered as deep constructivism that involves making a collective inquiry into a specific topic and coming to a deeper understanding through interactive questioning, dialogue, and continuous improvement of ideas. Ideas are thus the medium of operation in KB environments ( 20 ).

Key point: Knowledge building projects focus on understanding rather than on accomplishing tasks, and on collaboration rather than on controversy ( 20 ).

Knowledge processing : Knowledge filtering, knowledge synthesis, knowledge integration, knowledge refinement, knowledge customization.

Knowledge processing attributes

Context: Knowledge processing is a significant factor contributing to socioeconomic sustainability ( 21 ).It is a central problem of Artificial Intelligence ( 22 ).

Purpose: The purpose of Knowledge processing is to understand the relationship among data, information and knowledge and create knowledge structures ( 23 ).

Method: The knowledge processing method is Transformation of data into knowledge, changing the form of knowledge representation, deriving new knowledge from a given knowledge ( 23 ).

Steps: Knowledge processing consists of the following steps: Information storing, information retrieving, and information transferring ( 21 ).

Key point: Knowledge processing is known as the most important factor affecting economic and social sustainability, Derive value from knowledge processing ( 23 ).

Knowledge filtering attributes

Context: Knowledge filtering can be used to facilitate assimilation. Filtering tries to get the right knowledge to the right person at the right time) 24).

Purpose: Filtering is a tool to help people find the most valuable information so that the limited time spent on reading/listening/viewing can be spent on the most interesting and valuable documents. Filters are also used to organize and structure information ( 25 ).

Steps: Knowledge filtering consists of the following steps: Evaluate documents, and puts documents, which are interesting into its structured information database) 25).

Method: The knowledge filtering method is Manual filtering by people, using intelligent agents ( 24 ).

Main actors: Computer-based Approaches, publishers, editors, journalists ( 25 ).

Knowledge synthesis attributes

Context: Knowledge synthesis is the contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic ( 26 ).

Purpose: Most syntheses are conducted either for the purpose of knowledge support or for decision support ( 27 ).

Steps: Knowledge synthesis consists of the following steps: Stating the objectives of the research, Defining eligibility criteria for studies to be included, Identifying (all) potentially eligible studies, Applying eligibility criteria, Assembling the complete data set feasible including data extraction, quality appraisal of included studies, Analyzing this data set, and Preparing a structured report ( 28 , 29 ).

Method: Knowledge synthesis methods are Systematic review, Realist syntheses, Narrative syntheses, Meta-analyses, Meta-syntheses, Practice guidelines, Consensus conference, or expert panel ( 30 ).

Key point: A synthesis must be reproducible and transparent in its methods ( 26 ).

Knowledge integration attributes

Context: The integration of knowledge is the process of incorporating new information into a body of existing knowledge ( 31 ).

Purpose: The purpose of knowledge integration is to determine how new and existing knowledge interacts and how existing knowledge should be modified to accommodate the new information ( 31 ).

Steps: Knowledge integration consists of the following steps: Dynamic process of linking, connecting, distinguishing, organizing, and structuring ideas about scientific phenomena ( 32 ).

Knowledge refinement attributes

Context: The knowledge refinement process is implemented as part of an organization’s knowledge management efforts ( 33 ).

Purpose: The purpose of knowledge refinement is to optimize content quality ( 33 , 34 ).

Steps: Knowledge refinement refers to the process of evaluating, analyzing and optimizing the knowledge object to be stored in a repository ( 35 , 36 )

Key point: Knowledge refinement effectiveness is defined as the degree to which the refinement process produces quality knowledge ( 37 ). Knowledge refinement process should positively enhance the quality of refined knowledge ( 37 ).

Knowledge customization attributes

Context: Product customization is becoming an increasingly important strategic initiative in knowledge management. Product customization impacts the knowledge management processes of knowledge acquisition, sharing, and transfer ( 38 ).

Purpose: The purpose of customization is configuring a product or service to a buyer’s specifications ( 39 ). The relationships among sales, R&D, and production functions have to strengthen and the KM system has to support such a need ( 38 ).

Steps: Knowledge customization consists of the following steps: Collecting information about the customer, choosing options and/or creating new content, deliberately tailors content ( 40 ).

Key point: Customization emphasizes the user’s role in specifying content; customization is a highly user-driven process of tailoring ( 41 ).

Knowl edge transfer attributes

Context: The transfer of knowledge in the broadest sense refers to the flow of knowledge between and within organizations ( 42 ).

Purpose: The purpose of knowledge transfer is: decision-making, changing individual or organizational behavior, developing policies, problem-solving ( 43 ).

Perspectives about Knowledge Transfer: Health perspective, educational perspective, management perspective.

Health perspective: Use of scientific research findings to improve professional performance ( 44 ).

Educational perspective: Using generated knowledge in a specific context for another context ( 45 ).

Management perspective: utilization of the new knowledge for organizational behaviors ( 46 ).

Form: Knowledge transfer can be done in the form of formal and informal, planned, and unplanned ( 46 ). Planned and unplanned: Knowledge transfer as a process where knowledge is transmitted from one person to another in the form of planned or natural ( 47 ).

Formal and informal: Knowledge transfer as an informal way through networks and social interactions in the workplace or formal way in an organization ( 47 , 48 )

Level: Knowledge transfer is a macro process, at the organizational level ( 42 ).

Steps: Knowledge transfer consists of the following steps: SECI: Socialization, Externalization, Combination, And Internalization ( 49 ).

Areas: Knowledge transfer areas include: Transfer of research findings ( 50 ). Technology transfer ( 51 ). Transfer of learning, Organizational transfer. ( 45 ).

Key point: The concept of knowledge transfer is at the macro level, where knowledge is spreading across sectors, units, or subsets of an organization ( 42 ).

Knowledge sharing attributes

Context: Knowledge sharing is an activity that involves transferring or disseminating knowledge from a person, group, or organization to another.

Purpose: The purpose of knowledge sharing is discovering tools for accessing knowledge inside and outside of organizations with a view to creating more effective management and organizational system ( 52 ).

Level: Knowledge sharing can be At the Individual level and micro ( 53 ). Among researchers, policymakers, service providers, stakeholders ( 54 ).

Activities: Sharing of knowledge is entirely conscious, with a person's desire, without any obligation ( 53 ).

Place for sharing Sharing of knowledge occurs at Conferences, social media, Media relation, Scholarly collaboration networks, Journal publication ( 55 )

Direction: It is a Mono directional process: A person's knowledge transforms into a form that can be understood, absorbed, and used by others. Bidirectional: Share information, ideas, suggestions and related organizational expertise with each other ( 56 ).

Key point: Common purpose and shared experiences between individuals, and Communication with others are taking place ( 56 ).

Kn owledge exchange attributes

Context: In the exchange of knowledge, collaborative problem solving between researchers and decision-makers takes place ( 54 ).

Purpose: The exchange of knowledge is to increase the effectiveness of networks and teams in complex environments ( 54 ). The exchange of knowledge to create new knowledge ( 57 ).

Form: Knowledge exchange is an active process: Researchers make knowledge available to users, and users also transfer knowledge to researchers. It Includes knowledge sharing (what employees give to others) and knowledge search (employees are seeking knowledge from others). ( 57 ).

Direction: There are bidirectional relations between researchers or knowledge producers and users.)58).

Key point: The interactions between researchers and decision-makers take place ( 57 ).

Knowledge dissemination attributes

Means for dissemination: Knowledge can be disseminated through articles, journals, conference lectures and other outputs ( 59 ).

The type of dissemination: Dissemination of knowledge is in the form of Knowledge, interventions and existing or recent methods ( 59 )

Direction: It is mono-directional, from the top to the bottom and from the expert ( 59 ).

Form: Knowledge dissemination is a planned process ( 59 ).

Knowledge publication attribute

Con text: One of the major academic duties to share their findings, and to interact with their peers and the general populace, via literal publication ( 60 ).

Purpose: The purpose of the publication is the Making-public of new knowledge ( 60 ).

Steps: Knowledge publication includes the following steps: Find the right journal, prepare the paper, and submit the paper ( 55 ).

Form: The publication of knowledge is in the form of Letter, rapid or short communications, Review papers, Full articles, Research elements (data, software, methods, Citable articles, in brief) ( 55 )

Key point: The publication is related to academic journals ( 55 ).

Knowledge Brokering

Knowledge brokering attributes.

Context: Knowledge brokering is one of the human forces behind knowledge transfer. It is a dynamic activity that goes well beyond the standard notion of transfer as a collection of activities that helps move information from a source to a recipient ( 61 ).

Purpose: Brokering focuses on identifying and bringing together people interested in an issue, people who can help each other develop evidence-based solutions. It helps build relationships and networks for sharing existing research and ideas and stimulating new work.” ( 62 ). Knowledge brokering encompasses a wide range of processes and practices that aim at establishing relationships and facilitating effective knowledge sharing and exchange ( 61 ).

Form: Knowledge brokering takes place as either formal or informal activities ( 61 ).

Type: Types of knowledge brokers are: Information Intermediary (Help Access to knowledge), Knowledge Intermediary (Help Understand and apply the knowledge), Knowledge Brokering (Help use of knowledge in decision making), Innovation Brokering (Changing Context). ( 61 )

Activities: Knowledge brokering activities are: uncovering the needs, ideas, activities, and processes of different knowledge environments in order to identify the best research, practices and tools that research partners need to capture, transfer, exchange and collaborate around knowledge ( 61 ).

Key point: It engages with obstacles that block the transfer of research into practice ( 61 ).

Knowledge storing: Knowledge assimilation, knowledge package, knowledge indexing, knowledge documentation.

Knowledge storage attributes

Context: Knowledge can be viewed as an item to be stored for future usage ( 34 ).

Purpose: Knowledge storage is In order to facilitate the assimilation of knowledge ( 63 ).

Type: Knowledge is stored in the form of individual and organizational knowledge, soft or hardstyle recording and retention ( 49 , 64 )

Form: Knowledge store as the form of documents, rules, cases, and diagrams ( 65 )

Method: Technical infrastructure such as modern informational hardware and software, human processes are necessary for storing knowledge ( 49 ).

Steps: Knowledge storage steps are: identify the knowledge in an organization, convert the identified knowledge to code, and index the identified knowledge for later retrieval ( 49 , 64 ).

Knowledge assimilation attributes

Context: A critical aspect of knowledge management is that of assimilation ( 66 , 67 ).

Purpose: 1. To take in and incorporate as one’s own; absorb 2. To bring into conformity with the customs, attitudes, etc. of a group 3. To convert to substances suitable for incorporation.

Steps: Knowledge assimilation steps are: Storage, massaged, organized, integrate, filtered, navigate ( 66 , 67 ).

Key point: Knowledge can be captured or created, but until it is assimilated it is not likely to receive extensive use ( 64 ).

Knowledge package attributes

Purposes : The purpose of the knowledge package is culling, cleaning and polishing, structuring, formatting, and/or indexing documents against a classification scheme ( 68 ).

Activities: Knowledge package activities include Authoring knowledge content, codifying knowledge into “knowledge objects” by adding context, developing local knowledge into “boundary objects” by deleting context, filtering and pruning content, and developing classification schemes ( 68 ).

Knowledge indexing attributes

Context: Knowledge index is to provide a summary about subject content; Indexing activity should be done as a pre analyzing process ( 69 ).

Purpose: The purpose of indexing is: organizing the Information in order to effectively use of information ( 70 ).

Steps: Knowledge index steps are: Review of documentation and establishment of subject matter, identify the core concept in documents, Referencing selected concepts by the terms of the indexing language ( 71 ).

Main actors: Librarian and intermediaries are the main actors for indexing of knowledge ( 71 ).

Knowle dge documentation attributes

Context: Preservation and documentation are ways to ensure the future existence of indigenous knowledge, which today is under threat of extinction ( 72 ). Facilitating re¬trieval knowledge is to take place from an organized data set (WIPO, 2016).

Purpose: The aim of documentation is to ensure the maintenance, use, and development of knowledge by present and future generations of peoples and communities ( 73 ).

Steps: Knowledge documentation steps are Knowledge identification, Knowledge fixation, and Knowledge classification ( 73 ).

Methods: The methods for documentation are Paper files, digital databases, archives, or libraries ( 73 ).

Main actors: Librarian and information professionals are the main actors for knowledge documentation ( 74 ).

Knowledge transfer : Knowledge sharing, knowledge exchange, knowledge dissemination, knowledge publication.

Knowledge capitalization : Knowledge commercialization, knowledge valorization.

Knowledge capitalization attributes

Context: Knowledge capitalization is the most important part of KM ( 75 ).

Purpose: It aims at building organizational memories that represent several views on expertise or activity (75.)

Activities: Capitalization is the process by which members of the community can identify, locate, model, store, access, use/reuse, share, update, and know-how to communicate the knowledge of the community ( 75 ).

Steps: Knowledge capitalization steps are: Knowledge extraction and formalization, Knowledge sharing, Knowledge reuse and appropriation, Memory evolution ( 75 ).

Form: Knowledge capitalization happens in the form of: Knowledge locate (identifying, localizing, characterizing, mapping, estimating, prioritizing), knowledge preserve (acquiring, modeling, formalizing, conserving), knowledge enhanced (accessing, disseminating, sharing, using more effectively, combining, and creating), knowledge actualized (appraising, updating, standardizing, enriching, knowledge managed (elaborate a vision: promote, inform, train, facilitate, organize, coordinate, encourage, motivate, measure, and follow up) ( 76 ).

Knowledge commercialization attributes

Context: Commercialization of knowledge is the Third mission of the university, Transfer of knowledge to industry ( 77 ).

Purpose: The purpose of commercialization is: Decrease independency to the public sector, Make commercial profit ( 78 ).

Direction: At the commercialization level Corporation between education and industry, dynamic improvement of production, and the economy system is taking place ( 78 ).

Steps: Knowledge commercialization steps include flowing: Idea generation, Idea evaluation, Idea development, Commercial analysis of the product, Market assessing, Commercialization ( 79 ).

Key point: Commercialization is not a linear process; it is a complex process ( 79 ).

Knowledge valorization attributes

Context: Valorization is a word of French origin translated as a “surplus value”. Valorization was framed in the context of the discourse of academic capitalism ( 80 ).

Purpose: The purpose of valorization is to transfer knowledge from one part to another for economic benefit” ( 81 ).

Path: The process of knowledge valorization is a long route that starts at universities ( 81 ). Valorization not only contributes to the availability of the results of academic research beyond academia but also involves the co-production of knowledge by academics and representatives of business ( 80 ).

Types: Types of valorization are societal (social) and economic ( 81 ).

Main actors: “Valorization is a cooperation between higher education institutions, government, and business players to agree on targeted investments in a number of key areas of regional innovation” ( 82 ).

Steps: Knowledge valorization steps are: Knowledge acquisition; amassing the relevant internal and external information required for the transfer of knowledge is collected and quickly deploying this information to its potential users, Knowledge processing; assess the market value of the relevant research and package the knowledge with market potential for business requirements, Knowledge dissemination; delivering of the knowledge package to business and assisting in the technology deployment ( 83 ).

Areas: Knowledge valorization areas include: education, Cooperation, contract research, R&D cooperation, and knowledge, and technology transfer, “entrepreneurship, “the production of successful high-tech start-ups” ( 84 ).

Key point: Knowledge-Economy Index which takes into account whether the environment is conducive for knowledge to be used effectively for economic development and Knowledge Index which measures a country’s ability to generate, adapt and diffuse knowledge ( 52 ). Valorization is broader than commercialization that is focused primarily on making a commercial profit ( 80 ).

Knowledge utilization: Knowledge adoption, knowledge adaptation, knowledge reuse.

Knowledge adoption attributes

Context: The adoption of knowledge is carried out in the field of innovation ( 46 ).

Purpose: Adoption is taking place in order to decision making about accept or refuse of innovation ( 46 ).

Steps: Knowledge adoption steps include: awareness about new knowledge, attitude formation, and decision about accept or refuse of innovation or new knowledge, implement a new idea or confirm accepted decision ( 46 ).

Key point: User motivation for use or rejection, resistance rate about new knowledge, consistency to the policy is determining factors in the knowledge adoption process ( 85 ).

Knowledge adaptation attributes

Context: The adaptation of knowledge is related to the results of the research, and this step is critical to the success of the knowledge transfer process ( 86 , 87 ).

Purpose: The goal is to make the results accessible and understandable by the users ( 86 , 87 ).

Key point: This step affects the user's decision to accept the knowledge generated by the researchers. Also, the availability of research results does not necessarily guarantee acceptance and use by users. Many authors have argued that the form of presentation of research results can be a motivation or obstacle to accepting knowledge in the educational community ( 87 ).

Knowledge reuse attributes

Context: It is a central issue for companies in order to avoid reinventing the wheel over and over again ( 89 ). The effective reuse of knowledge is arguably a more frequent organizational concern and one that is clearly related to organizational effectiveness ( 89 ).

Purpose: Knowledge reuse is taking place for sharing best practices or helping others solve common technical problems ( 88 ).

Steps: Knowledge reuse steps include: Capturing or documenting knowledge, packaging knowledge for reuse, Distributing or disseminating knowledge (providing people with access to it), and Reusing knowledge ( 35 ).

Activities: Knowledge reuse activities are followings: recall (that information has been stored, in what location, under what index or classification scheme) and recognition (that the information meets the users’ needs), as well as actually applying the knowledge ( 90 ).

Agent: There are three major roles in the knowledge reuse process: knowledge producer—the originator and documenter of knowledge, who records explicit knowledge or makes tacit knowledge explicit, knowledge intermediary—who prepares knowledge for reuse by eliciting it, indexing it, summarizing it, sanitizing it, packaging it, and who performs various roles in dissemination and facilitation, and knowledge consumer—the knowledge reuser, who retrieves the knowledge content and applies it in some way ( 91 ).

Key point: Successful knowledge transfer or reuse requires a complete solution. It is not just a matter of providing access to information technology and repositories. It also means careful attention to the design of incentives for contributing to and using repositories and to the roles of intermediaries to develop and maintain repositories and to facilitate the process of reuse ( 89 ).

Knowledge translation attributes

Context: The translation is the process of putting research findings and the products of research into the hands of key audiences. It is the art of weaving together processes of research and practice ( 92 ).

Purpose: Knowledge Translation is impact-oriented- the overarching goal of KT is to improve systems, practices, and ultimately lead to better outcomes ( 93 ).

Activity: Knowledge Translation includes multiple activities- Researchers need to go beyond mere dissemination and publication of results to multiple engagements to effect knowledge uptake ( 93 ).

Direction: Knowledge translation is a nonlinear process- it is also a complex process with multiple players, it also needs multidirectional communications ( 93 ).

Agent: Knowledge translation is an interactive process- the interactions between knowledge producers and knowledge users should be continuous. KT requires ongoing collaborations among relevant parties- collaboration, relationships, and trust among parties ( 92 ).

Steps: Knowledge translation includes all steps between the creation of new knowledge and its application ( 93 ).

Key point: It emphasizes the use of research-generated knowledge ( 93 ).

Knowledge management attributes

Context: Knowledge management is the process of transferring information and intellectual assets to a stable value. And it is related to making knowledge suitable for the correct processor, such as a human being or a computer, at the right time and at the right cost ( 94 ).

Purpose: The purpose of knowledge management is to create the knowledge that can be used by more than one person, for example, for the organization as a whole, or sharing knowledge between its members ( 94 ). Help to promote the use and sharing of data and information in decision making ( 95 ).

Activity: Knowledge management involves planning, organizing, and controlling individuals, processes, and systems to ensure that knowledge capital is promoted and applied effectively ( 33 ).

Type: Knowledge management has multidisciplinary nature, which includes: organizational science, cognitive science, information technology, linguistics, technical writing, ethnology and sociology, teaching, Communication studies, collaborative technologies such as computer-based collaborative activities, intranets, extranets, portals, and other network technologies ( 96 ).

Path: Under the knowledge management, the information becomes applicable to the knowledge and is applicable to the people who can use it ( 97 ).

Steps: Knowledge management steps involve: obtaining, organizing, managing, and disseminating knowledge in an organization in order to perform tasks faster, reuse best practices, and reduce costs twice ( 49 ). The process of finding, selecting, organizing, importing, and providing information in order to help raise the understanding of employees in a particular area ( 98 ).

Form: Knowledge management has two main aspects: knowledge as an obvious concern that reflects on organizational strategies, policies, and practices. On the other hand, it takes into account the relationships between intellectual capital (both apparently recorded and implicit in the form of personal knowledge) and Positive business results ( 99 ).

Studies have examined one or a few concepts in the field of knowledge management. Through this study, we were able to investigate all of the concepts related to knowledge management as far as possible. By criticizing and comparing the evidence and definitions relating to them, based on semantic proximity, we divided them into related categories and, clarify the boundary among them. We realized that many concepts had not found their appropriate place in the KM process, and there are no proper definitions of them. Therefore, it is necessary to redefine some of the concepts and the correct placement in the structure and operation of knowledge management. We can use the results of this study as the basis and the first step in developing a comprehensive model that includes all the concepts related to knowledge management and for determining the relationship among them and with other educational development concepts.

This study aimed to clarify the concepts in the knowledge management area. Through critically reviewing the literature in this field, we were able to identify the concepts and realize their attributes. Therefore, we came to a new interpretation of the concepts. At the end of the study, we concluded that some of the concepts have not been properly defined and are not properly located in the knowledge management field, and their application is uncertain. Regarding the identified gaps, there is a need to comprehensively study that consider all of these in the direction of knowledge management, show their application in a comprehensive model and, if necessary, redefined them, such as study can complement our work.

Acknowledgment

This article is a part of the dissertation entitled Educational Development with Approach on Knowledge Management. The authors would like to appreciate everyone who assisted them in this research.

Conflict of Interests

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Cite this article as: Yazdani Sh, Bayazidi S, Mafi AA. The current understanding of knowledge management concepts: A critical review. Med J Islam Repub Iran. 2020 (28 p);34:127. https://doi.org/10.34171/mjiri.34.127

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Villy Satria Praditha , Muharman Lubis; A theoretical literature review on knowledge management framework. AIP Conf. Proc. 19 April 2024; 2987 (1): 020032. https://doi.org/10.1063/5.0199320

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Discovering the suitable technique and tools to effectively manage a company’s information is one of the most challenging challenges for any organization. The inability to obtain the right information in a timely manner, incorrect decisions based on incorrect information, and repetition of errors can have a negative effect on staff productivity, which can have an effect on the organization’s profitability. Knowledge management has been widely used in various businesses, governments, and other institutions. Finding, capturing, sharing, and utilizing various types of knowledge are all part of the knowledge management process, which aims to increase organizational performance. Theoretical Literature Review is used in this study to fully understand the theories already in existence, their relationships, and the degree to which they have been studied. The creation of research questions is the initial step in performing this study. After that, search for various genres of literature that were released in research journals between 2017 and 2021. SpringerLink, Excellence Research Australia (ERA), Science Direct, IEEE, and THESAI are some of the journal databases included in this study. The purpose of this research is to get a deeper understanding of the knowledge management framework, identify its weaknesses and strengths, as well as commonly used knowledge management methods and processes, as a guideline for future research to develop a more effective knowledge management framework. Observations of the knowledge management process within the knowledge management framework revealed that multiple knowledge creation, knowledge sharing, information repository, knowledge acquisition, and knowledge application procedures are frequently utilized. Regarding knowledge transformation and knowledge brokers, their use is currently infrequent. In addition, the knowledge management framework’s strengths include enhanced swifter decision-making, enhanced competitive advantage, increased cooperation & partnership management, increased constant innovation, the best organizational traits, increased worker productivity, and integrated management. Nonetheless, the management framework has several flaws, such as a data collection process with numerous questions that can lead to confusion in determining the issue’s focus, the absence of an evaluation process, the absence of framework testing, and the framework’s limited implementation that can only be used in domains. In the future, a better suitable framework can be created using the comparison of knowledge management frameworks.

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Journal of Knowledge Management

ISSN : 1367-3270

Article publication date: 19 October 2012

The aim of this paper is to review research on knowledge management in small and medium‐sized enterprises to identify gaps in the current body of knowledge, which justify future research directions.

Design/methodology/approach

The study consists of a systematic review of 36‐refereed empirical articles on knowledge management and small and medium‐sized enterprises.

The areas of knowledge management implementation, knowledge management perception, and knowledge transfer are relatively well researched topics; whereas those of knowledge identification, knowledge storage/retention and knowledge utilisation are poorly understood. Given the prevalence of small and medium‐sized enterprises there is a strong need for more research on this important topic. The future research directions proposed by the authors may help to develop a greater understanding of knowledge management in small and medium‐sized enterprises.

Research limitations/implications

By only using the ProQuest database this study may not have allowed a complete coverage of all empirical articles in the field of knowledge management in small and medium‐sized enterprises. Yet, it is believed that the findings provide a valuable understanding of the current situation in this research field. The study proposes a number of future research directions, which may stimulate more intensive research in this important field.

Originality/value

To the best of the authors' knowledge, no systematic literature review on this topic has previously been published in academic journals.

• Knowledge management
• Small to medium‐sized enterprises
• Systematic review
• Entrepreneurship

Durst, S. and Runar Edvardsson, I. (2012), "Knowledge management in SMEs: a literature review", Journal of Knowledge Management , Vol. 16 No. 6, pp. 879-903. https://doi.org/10.1108/13673271211276173

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• Corpus ID: 52034027

A Literature Review of Knowledge Management: History, Concept, and Process

• Riyadhi Fernanda , M. Salwa
• Published 2018

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Structural Equation Modeling to Explore the Relationship Between Organizational Culture Dimensions and Implementation of Knowledge Management in Teaching Hospitals

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Digital Technology Innovation as a Catalyst for Real Economy Enhancement: A Chinese Perspective

• Published: 25 June 2024

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The study explored the influence of digital technology innovation on enterprises’ primary business performance within the digital economy’s integration with the real economy. By analyzing data from Chinese A-share listed companies between 2013 and 2021 and utilizing digital technology patents’ IPC classification numbers to measure innovation, this research investigates the impact of digital innovation on enhancing the main business performance of enterprises and real economic growth. Further, the paper enhances the robustness of the results through endogeneity and robustness tests. The results demonstrate that digital innovation improves enterprise performance by optimizing corporate internal control and corporate workforce structure. This research elucidates the significance of the intellectual property environment and digital infrastructure through the analysis of heterogeneity. Additionally, this study explores the positive effects of advanced technical skills and manufacturing companies, particularly in the machinery, equipment, and information manufacturing sectors while also considering the detrimental impact of financialization trends within firms. In the further analysis, the research concludes that digital technology innovation significantly contributes to boosting total factor productivity (TFP) in companies with lower levels of digital transformation. This study enriches discussions on technology management, innovation, and the knowledge economy by providing empirical evidence of digital technology’s role in advancing the real economy and offering actionable insights for policy development to promote digital innovation within organizations, especially in emerging economies like China where digital transformation is still evolving.

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This work was supported by the Department of Science and Technology of Liaoning Province, China (grant no. 2021JH4/10100029).

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Zhang, B., Chen, P. Digital Technology Innovation as a Catalyst for Real Economy Enhancement: A Chinese Perspective. J Knowl Econ (2024). https://doi.org/10.1007/s13132-024-02093-7

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Climate change and heat stress resilient outdoor workers: findings from systematic literature review

• Peymaneh Habibi 1 ,
• Jaleh Razmjouei 2 ,
• Amirhossein Moradi 3 ,
• Farank Mahdavi 1 ,
• Saeed Fallah-Aliabadi 4 , 5 &
• Ahad Heydari 6  

BMC Public Health volume  24 , Article number:  1711 ( 2024 ) Cite this article

Metrics details

Global warming has led to an increase in the number and intensity of extreme heat events, posing a significant threat to the health and safety of workers, especially those working outdoors, as they often have limited access to cooling strategies. The present systematic literature review (a) summarizes the current knowledge on the impacts of climate change on outdoor workers, (b) provides historical background on this issue, (c) explores factors that reduce and increase thermal stress resilience, (d) discusses the heat mitigation strategies, and (e) provides an overview of existing policy and legal frameworks on occupational heat exposure among outdoor workers.

Materials and methods

In this systematic review, we searched scientific databases including Scopus ( N  = 855), Web of Science ( N  = 828), and PubMed ( N  = 202). Additionally, we identified relevant studies on climate change and heat-stress control measures through Google Scholar ( N  = 116) using specific search terms. In total, we monitored 2001 articles pertaining to worker populations (men = 2921; women = 627) in various outdoor climate conditions across 14 countries. After full-text assessment, 55 studies were selected for inclusion, and finally, 29 eligible papers were included for data extraction.

Failure to implement effective control strategies for outdoor workers will result in decreased resilience to thermal stress. The findings underscore a lack of awareness regarding certain adaptation strategies and interventions aimed at preventing and enhancing resilience to the impact of climate change on heat stress prevalence among workers in outdoor tropical and subtropical environments. However, attractive alternative solutions from the aspects of economic and ecological sustainability in the overall assessment of heat stress resilience can be referred to acclimatization, shading, optimized clothing properties and planned breaks.

The integration of climate change adaptation strategies into occupational health programs can enhance occupational heat resilience among outdoor workers. Conducting cost-benefit evaluations of health and safety measures for thermal stress adaptation strategies among outdoor workers is crucial for professionals and policymakers in low- and middle-income tropical and subtropical countries. In this respect, complementary measures targeting hydration, work-rest regimes, ventilated garments, self-pacing, and mechanization can be adopted to protect outdoor workers. Risk management strategies, adaptive measures, heat risk awareness, practical interventions, training programs, and protective policies should be implemented in hot-dry and hot-humid climates to boost the tolerance and resilience of outdoor workers.

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Introduction

Extreme weather events and severe heat pose significant hazards to the safety and health of workers, leading to increased accidents, mortality, and morbidity during hot climate conditions [ 1 , 2 , 3 ]. Global warming presents a new and formidable challenge for most countries [ 4 , 5 ]. Global climate change substantially affects physiological and perceptual responses through both direct and indirect effects on core body temperature [ 6 ], heart rate, skin temperature, and thermal comfort [ 7 , 8 , 9 ]. Working in hot and humid environments during long shifts with high physical activity can jeopardize the safety and health of worker populations [ 7 , 10 ]. Increased exposure to thermal stress among workers in outdoor environments has been documented in tropical and subtropical countries with hot seasons [ 11 ]. Exposure to hot working environments, and the resulting elevated physiological and perceptual responses, can lead to occupational heat stress, reducing safety, health, and work capacity [ 12 ], and increasing the risk of heat-related illnesses (HRI) [ 13 ]. The increment in the levels of ambient temperature, radiation and shifts in the distribution of daily peak temperature can cause indirect and direct effects on outdoor workers [ 14 , 15 ]. High temperatures and high humidity can exacerbate the effects of physical workload on individuals working outdoors during long shifts in developing and tropical countries [ 16 ]. Working in high-temperature and high-humidity environments can have adverse health effects on workers, particularly agricultural workers, construction workers, drivers, sellers, brick-making workers, and daily wage workers [ 17 , 18 ]. High hot-humid and hot-dry temperatures can lead to occupational heat strain when core body temperature rises above 38 °C [ 19 ]. Exposure to heat radiation, either when working outdoors with exposure to the sun or around hot machinery, can greatly increase physiological pressure and lead to reduced work capacity [ 20 ].These physiological mechanisms worsen under high climate conditions and climate change, emphasizing the need to identify strategies to increase occupational heat stress resilience and develop solutions and policies to protect the health and safety of outdoor workers [ 21 , 22 ]. Projected future global warming conditions will dangerously affect the anticipated occupational heat stress resilience of outdoor workers worldwide. There is insufficient knowledge regarding strategies to increase occupational heat stress resilience, necessitating protective measures against heat stress and climate change to reduce health risks and fatalities for future outdoor workers in hot and humid work environments. The findings of this study can inform planning for increasing occupational heat stress resilience, developing heat acclimation strategies, and identifying risk factors to mitigate heat stress caused by global warming, particularly in middle- and low-income communities.

Search strategy

This systematic literature review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines [ 23 ]. We searched scientific databases, including PubMed, Scopus, and Web of Science, and identified additional records through Google Scholar. We used Mesh terms in PubMed to identify synonyms for ‘climate change’ and ‘thermal resistance.’ We also consulted specialists to identify relevant keywords. Our search syntax was developed and applied to title, abstract, or keyword queries in selected databases. To ensure the specificity and accuracy of our search strategy, we tested the number needed to read (NNR) in the Web of Science database. We also investigated the references of included studies and searched key journals via Scopus to identify potentially relevant articles. The full search strategy in three main databases has been mentioned in Appendix 1. Our search syntax was as follows:

PubMed: (“heat wave”[tiab] OR “heat stress”[tiab] OR “climate change*”[tiab] OR (climate[tiab] AND change[tiab]) OR “extreme weather”[tiab] OR “extreme heat”[tiab] OR “global warming”[tiab] OR “hot day*”[tiab] OR “warm day*”[tiab]) AND (“heat tolerance“[tiab] OR “heat resilien*“[tiab] OR (heat[tiab] AND resilien*[tiab]) OR (heat[tiab] AND tolera*[tiab]) OR “Heat resistan*”[tiab] OR thermotolerance[tiab] OR “heat endurance”[tiab] OR (heat[tiab] AND endur*[tiab])) AND (worker*[tiab] OR Firefighter*[tiab] OR “fire fighter*”[tiab] OR firem*[tiab] OR “fire m*”[tiab] OR nurs*[tiab] OR operator*[tiab] OR driver*[tiab] OR farmer[tiab]* OR welder*[tiab] OR miner*[tiab] OR employee[tiab] OR laborer*[tiab] OR labour*[tiab]).

Inclusion criteria

The research question components (PECO) were as follows: P (workers), E (Exposure), C (heat stress), and O (increase occupational heat stress resilience). We included studies that (a) measured physiological and perceptual responses in workplaces and resting environments of workers; (b) studied working populations, including both males and females (healthy and unhealthy populations); (c) assessed the impact of climate change on occupational heat strain, as well as the health, safety, and well-being of workers including work-related variables (income, work type, time), environmental variables (wet-bulb globe temperature (WBGT), relative humidity), physiological variables (heart rate, respiratory, rate of perceived exertion (RPE)), and demographic variables (age, sex, body mass index (kg/m 2 ); (d) focused on air temperature, relative humidity (RH), heat waves, solar radiation, climate change, UV radiation, and thermal stress; (e) considered local and international contexts, countries, and workplaces; and (f) investigated workers’ perceptions of climate change, occupational heat strain, and their knowledge and attitudes toward adaptation strategies.

Exclusion criteria

Studies were excluded if they (a) studied climate change-related phenomena such as storms, cyclones, rainfall, rising sea levels, and drought; (b) evaluated the impact of climate change on plants, crop yields, pest dynamics, soil processes, water availability, and animals; (c) had inaccessible full-texts; or (d) focused on indoor workplaces.

Screening and selection

We entered all identified studies into EndNote and removed duplicates. One team member (PH) screened studies based on their titles and abstracts, and two members of the research team (AH and PH) independently selected relevant studies by reviewing the full texts. Disagreements regarding study inclusion were resolved through team discussion. We also conducted searches in three key journals: environmental research, urban climate, and global environmental change, but did not identify any additional studies.

Data extraction and quality assessment

Two team members (AH and PH) independently assessed the eligibility of included studies based on our inclusion and exclusion criteria. They also evaluated the methodological quality of selected studies using the quality assessment tool for studies with diverse designs (QATSDD), which consists of 16 items and is a reliable and valid tool for assessing the methodological quality of various types of studies [ 24 ]. Any disagreements regarding study inclusion were resolved through team discussion.

Search results

The numbers of identified studies and the studies reviewed during the screening and selection stages are presented in Fig.  1 . The initial search yielded 2001 articles including the additional articles sourced from Scholar Google. After full-text assessment, 55 studies were selected for inclusion, and finally, 29 eligible papers were included for data extraction. No additional studies meeting our eligibility criteria were identified after the full-text investigation. Similarly, no studies were identified through searches of key journals and the references of included studies. Table  1 provides details on the selected studies, including author/year, study location, document type, population/sample size, climate conditions, assessment of physical, perceptual, and physiological factors, authors’ conclusions, and quality ratings. Table  2 presents suggestions for increasing and decreasing occupational heat stress resilience among outdoor workers.

Flow diagram of the screening process of included studies the strategies to increase occupational heat stress resilience among outdoor workers

Descriptive analysis

Out of the 29 selected studies, 18 addressed global warming’s impact on occupational heat stress resilience, risk management strategies, and adaptation strategies for warming conditions. Most of these studies emphasized that climate change will exacerbate the health impacts of extreme heat. The prevalence of negative effects due to climate change will intensify workers’ health risks in future work scenarios, particularly in regions with hot and humid climates and poor economic conditions. As of our selection period until 2023, 20 studies (68.96%) were published between 2016 and 2023. Of the 29 assessed papers, 18 (62.06%) directly investigated the effects of climate change and adaptation strategies for outdoor workers in various countries, including Australia, the USA, China, Japan, Africa, Korea, Slovenia, Taiwan, Indonesia, Ghana, Korea, India, Iran, and Pakistan. The predominant themes identified in these papers revolved around strategies to increase occupational heat stress resilience. In conclusion, the study’s findings were categorized into main themes, including risk factors that decrease occupational heat stress resilience and suggestions for increasing occupational heat stress resilience among outdoor workers.

Thematic content analysis

This systematic review provides a summary of evidence published to date regarding strategies to enhance occupational heat stress resilience, especially in hot outdoor workplaces. Despite variations in study design and analytical approaches, the evidence presented in this systematic review consistently highlights a strong association between thermal stress resulting from global warming and occupational heat stress. Broad findings from these studies indicate that exposure to heatwaves and global warming is linked to adverse health impacts on workers.

Furthermore, several studies underscore the need for sentinel effects and leading indicators to facilitate surveillance of climate-related occupational heat stress effects, as well as strategies and interventions for preventing the impact of climate change on outdoor workers. Finally, the review identifies interventions and adaptation strategies for outdoor workers, including the provision of accessible cool drinking water [ 13 , 26 , 41 , 44 , 47 ], optimized work-rest schedules [ 12 , 13 , 16 , 26 , 36 , 43 , 44 , 47 ], the availability of proper resting shade [ 16 , 47 , 49 ], training and awareness programs [ 20 , 38 , 40 ], self-paced work [ 13 , 38 , 40 , 44 , 47 ], and the use of supportive protective equipment [ 41 ].

Factors that reduce resilience to climate change among outdoor workers

Resilience to climate change among outdoor workers can be reduced by various factors, categorized into personal risk factors, environmental risk factors, and occupational-related heat exposure risk factors during work.

Individual-related heat exposure risk factors

Personal factors associated with reduced resilience to climate change, identifiable from outdoor workers’ data, include dehydration [ 20 , 25 , 28 , 32 , 34 , 37 , 40 , 46 , 47 , 48 ], unique medical characteristics [ 41 , 47 ], pregnancy [ 38 , 40 , 47 ], BMI [ 29 , 30 , 37 , 40 , 47 , 49 ], obesity and body fat [ 29 , 30 , 32 , 34 , 47 ], overall health status [ 33 , 34 , 37 , 47 ], lack of sleep [ 33 , 34 , 40 , 47 ], experience of a previous HRI [ 32 , 34 , 44 , 45 , 46 , 47 ], presence of certain concurrent diseases and chronic disease [ 35 , 47 ], kidney disease [ 20 , 26 , 38 , 43 , 46 , 47 ], consumption of caffeine and alcohol [ 26 , 28 , 30 , 34 , 37 , 40 , 41 , 46 , 47 ], smoking [ 30 ], use of drugs [ 26 , 37 , 40 , 41 , 47 ], age [ 16 , 33 , 35 , 38 , 39 , 40 , 41 , 46 , 47 ], older workers with low education [ 38 , 40 , 43 , 44 , 46 , 47 ], physical fitness [ 26 , 32 , 40 , 47 ], metabolism rate [ 40 , 47 ], type of clothing [ 40 , 47 ], prior heat injury [ 40 , 46 , 47 ], physical activity and heavy workload [ 16 , 27 , 31 , 34 , 38 , 39 , 40 , 46 , 47 , 48 ], gender [ 16 , 33 , 35 , 38 , 39 , 40 , 41 , 46 , 47 ], education level [ 16 , 39 , 41 , 44 , 46 , 47 ], wearing PPE [ 16 , 26 , 27 , 31 , 38 , 39 , 44 , 46 , 47 ], and non-acclimatization [ 29 , 32 , 37 , 40 , 41 , 43 , 44 , 47 ]. Physiological risk factors most frequently expressed by outdoor workers included excessive heart rate [ 30 , 45 , 47 , 49 ], oral [ 47 , 49 ], skin [ 45 , 46 , 47 , 49 ], core temperature [ 26 , 27 , 29 , 31 , 32 , 34 , 45 , 46 , 47 , 48 , 49 ], sweating [ 39 , 47 ], and blood pressure [ 45 , 46 , 47 , 49 ]. This is often followed by heat exhaustion [ 47 , 48 ] or tiredness [ 47 ], headaches [ 47 ], heat rash [ 47 ], and fainting [ 47 ]. Older adults are more vulnerable to chronic dehydration [ 28 , 45 ], especially those living with multiple chronic diseases [ 43 , 47 ]. Aging is also associated with reductions in sweat production [ 8 ]. Consequently, studies have generally reported greater elevations in body heat storage and core temperature in older compared to younger adults during environmental heat exposure [ 26 , 37 , 46 , 47 ]. Additionally, personal factors correlated with occupational heat strain include the adequacy of water intake [ 41 , 47 ].

Environmental-related heat exposure risk factors

The environmental factors contributing to thermal stress include high air temperature [ 12 , 16 , 26 , 27 , 31 , 34 , 40 , 45 , 46 , 47 , 48 , 49 ], heat wave [ 43 , 47 , 48 ], airspeed and movement around the workplace [ 16 , 43 , 45 , 47 , 48 , 49 ], high levels of heat exposure (WBGT = 37.5–49 ℃) [ 38 , 46 , 47 ], tropical nights [ 48 ], working in sun- exposed conditions [ 16 , 38 , 39 , 47 ], solar radiation [ 26 , 40 , 43 , 46 , 47 , 48 ], high humidity [ 16 , 27 , 31 , 34 , 40 , 43 , 45 , 47 , 48 , 49 ], UV radiation [ 26 , 47 , 48 , 49 ], the moisture content of the outdoor settings or workplaces [ 16 , 39 ], radiant heat [ 16 , 26 , 31 , 36 , 45 , 47 , 48 ], and the air-pollution index [ 30 ].

Occupational-related heat exposure risk factors

However, workers encounter various barriers, such as inadequate cool housing designs for rest [ 38 ], a lack of management and engineering commitment [ 41 , 42 , 47 ], heavy physical workloads for long hours [ 16 , 47 ] or physically demanding jobs [ 44 , 46 ], insufficient awareness and prevention training [ 38 , 40 , 41 , 43 , 47 ], a lack of knowledge regarding adaptive behavior [ 41 , 43 ], the absence of occupational heat stress guidelines and adaptation strategies [ 38 , 41 , 46 , 47 ], a lack of regular training on adaptation measures [ 41 ], limited management commitment [ 41 ], the nature of the physical workload [ 16 , 40 , 41 , 46 , 47 ], the absence of specific thermal stress-related policy regulations [ 41 ], working in proximity to heat sources [ 16 , 44 , 47 ], the type of protective clothing [ 16 , 40 , 47 ], limited access to innovative technology and equipment [ 41 ], the nature of the work [ 40 , 41 , 46 , 47 ], inadequate management commitment, work-break regimes [ 43 , 47 ] and cooling systems [ 26 , 28 , 40 , 41 , 47 , 48 ]. Additionally, workers face challenges such as inadequate knowledge of adaptive behavior [ 41 , 46 ], a lack of regular training on thermal stress risk, adaptation, and safety measures [ 41 , 47 ], a deficiency in specific heat-related policies and regulations [ 41 ], limited management commitment to heat-related health and safety measures [ 41 ], restricted access to innovative equipment and technology [ 41 ], insufficient regular breaks and work-rest time [ 35 , 39 , 41 , 46 , 47 ], limited access to shade [ 38 , 43 , 47 ], inadequate financial resources [ 38 , 41 ], the absence of an acclimatization program [ 41 , 43 , 47 ], suboptimal water management [ 47 ], and insufficient medical attention when implementing adaptation strategies for climate change and occupational heat stress.

Factors that enhance resilience to climate change among outdoor workers

Enhanced resilience to climate change can be achieved through various means, including personal, managerial, and engineering protective factors.

Personal protective factors

Outdoor workers can take several measures to protect themselves. They should consider adjusting their work schedule [ 35 , 47 ], maintaining adequate hydration [ 28 , 33 , 35 , 37 , 38 , 39 , 40 , 47 ], adjusting their clothing [ 31 , 35 , 47 ], drinking more water [ 35 ] or drinking plenty of cool water frequently before feeling thirsty [ 13 , 26 , 41 , 44 , 47 ]. It’s important to take more frequent planned breaks [ 35 , 38 , 44 ], wear broad-brimmed hats [ 35 , 39 , 41 , 47 ] and ventilated helmets [ 28 ], understand how to self-pace [ 13 , 38 , 40 , 44 , 47 ], wear sun-protective gear [ 38 , 49 ], including sunglasses and gloves during hot weather conditions [ 41 ], and take work breaks and rest in cooler or shaded areas [ 13 , 28 , 33 , 35 , 38 , 39 , 40 , 41 , 43 , 44 , 47 ]. Using sunblock [ 38 , 39 , 44 ], and having a higher education level [ 39 , 44 , 47 ], are also beneficial. Workers should consider wearing loose and light-colored clothing [ 28 , 34 , 35 , 38 , 39 , 41 , 44 ] and opting for short-sleeved shirts and shorts when possible [ 13 ]. Using cooling vests [ 27 , 47 ], implementing a ‘Buddy system’ [ 47 ], acclimatization [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 47 ], maintaining normal anthropometric measures [ 29 ], and changing clothing ensembles to more breathable single-layer garments [ 43 ] can further enhance personal protection.

Managerial protective factors

Maintaining good quality working conditions and a suitable climate can significantly improve worker performance, productivity, and company profits [ 37 ]. Workplace management and training programs [ 16 , 35 , 38 , 40 , 41 , 47 , 49 ] are crucial for worker well-being. Developing prevention strategies [ 12 , 13 , 38 , 48 ], improving guidelines for worker safety, health, and productivity, and adhering to occupational health standards [ 12 , 38 , 47 ] are essential. Scheduling heavy routine outdoor work during the early morning [ 47 ] or evening hours or in shaded areas [ 13 , 41 , 44 , 49 ] can help mitigate heat stress. Providing access to cooling systems, such as air conditioning and fans [ 13 , 16 , 26 , 38 , 39 , 40 , 41 , 44 , 47 ], and offering climate change adaptation strategies [ 13 , 48 , 49 ] are beneficial. Adjusting the duration of breaks/rest periods [ 12 , 13 , 16 , 26 , 36 , 43 , 44 , 47 ], ensuring access to shade [ 16 , 47 , 49 ], and providing access to drinking water or implementing programs to improve hydration status [ 13 , 16 , 20 , 25 , 44 , 47 , 49 ] are important managerial measures. Training workers in heat-related illness prevention [ 20 , 38 , 40 ], providing access to medical attention [ 20 ], sharing heavier jobs and rotating job assignments on shift schedules [ 13 , 41 , 47 , 49 ], offering air-conditioned vehicles [ 13 , 38 , 47 ], promoting climate change awareness to support healthy lives and decent jobs [ 39 ], implementing work stoppages if the daily maximum temperature exceeds 40 °C [ 13 , 44 , 47 ], raising worker awareness about heat risks [ 47 ] modifying work habits [ 49 ], considering the TWL [ 30 ], and promoting the understanding of the need for workers to self-pace during hot weather [ 13 , 38 , 47 ] are all valuable managerial protective factors.

Engineering protective factors

Providing and designing regular breaks in shaded areas [ 38 , 47 ], implementing strategies to eliminate or replace thermal stress risks [ 37 , 44 ], installing a central cooling system [ 13 , 44 , 47 ], halting work during periods of high thermal stress and supplying mechanical equipment [ 41 , 47 ], initiating heat-shield projects [ 47 ], and enhancing ventilation [ 38 , 39 , 44 , 47 ].

Our systematic review’s outcomes help us understand strategies for increasing occupational heat stress resilience and assessing the effects of global warming on outdoor workers’ adaptation strategies. This is particularly crucial in numerous warm workplaces, especially in low- and middle-income countries. The implementation of strategies to ensure adequate hydration, including access to drinking water and programs to improve hydration status [ 13 , 16 , 20 , 25 , 44 , 47 , 49 ], is one of the most critical interventions for managing warm workplaces. Hydrated workers [ 28 , 33 , 35 , 37 , 38 , 39 , 40 , 47 ] are more likely to maintain an acceptable work rate and physical activity without health risks in various hot-dry and hot-humid weather conditions [ 25 ]. Employers bear the responsibility of providing a safe work environment, conducting training and awareness programs [ 16 , 35 , 38 , 40 , 41 , 47 , 49 ], supervision [ 50 ], and providing suitable protective equipment to mitigate the negative effects of thermal stress due to global warming on safety and health [ 26 , 49 ]. Cooling the core body temperature through wearable liquid cooling garments (SCG) [ 27 ], evaporative cooling garments (ECGs) [ 15 ], fluid cooling garments (FCGs) [ 51 ], hybrid cooling (HBCGs) [ 52 ], and phase change materials (PCMs) [ 53 ] worn by individuals who require personal protective equipment [ 47 , 54 ], including firefighters and construction workers, significantly reduces occupational heat strain and enhances thermal comfort and performance [ 32 ]. Chan et al. recommend implementing appropriate protective measures, such as work-rest schedules and heat tolerance guidelines, to ensure the safety and health of personnel exposed to hot weather conditions [ 28 ]. Therefore, it’s advisable to conduct further research on work-rest schedule optimization models for workers, particularly in the context of construction workers [ 28 ]. It is recommended that safe work durations should be modified based on expected type of clothing and work intensity [ 55 ]. Our review’s results indicate that personal risk factors such as dehydration [ 20 , 25 , 28 , 32 , 34 , 37 , 40 , 46 , 47 , 48 ], smoking [ 30 ] and alcohol-drinking habits [ 26 , 28 , 30 , 34 , 37 , 40 , 41 , 46 , 47 ], age [ 16 , 33 , 35 , 38 , 39 , 40 , 41 , 46 , 47 ], BMI [ 29 , 30 , 37 , 40 , 47 , 49 ], and non-acclimatization [ 29 , 32 , 37 , 40 , 41 , 43 , 44 , 47 ]; as well as work-related factors like work-rest cycles [ 35 , 39 , 41 , 46 , 47 ] and environmental risk factors such as air temperature [ 12 , 16 , 26 , 27 , 31 , 34 , 40 , 45 , 46 , 47 , 48 , 49 ], relative humidity (RH) [ 16 , 27 , 31 , 34 , 40 , 43 , 45 , 47 , 48 , 49 ], heat radiant [ 16 , 26 , 31 , 36 , 45 , 47 , 48 ], and Thermal Work Limit (TWL) [ 30 ], are significant predictors for determining the physiological responses to HRI among outdoor workers [ 30 ]. More efforts should be made to educate workers and employers about the effects of occupational heat stress on safety, health and performance, and appropriate screening protocols (pre-employment and periodic examinations) should be included in health and safety legislation [ 56 ].

Educating outdoor workers about physiological and perceptual responses to HRI [ 20 , 38 , 40 ] and heat acclimation under uncompensated thermal stress [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 47 ], as well as emphasizing cooling techniques and fluid intake [ 28 , 33 , 35 , 37 , 38 , 39 , 40 , 47 ], is essential. Furthermore, it’s necessary to investigate the impact of gender (both women and men) [ 16 , 33 , 35 , 38 , 39 , 40 , 41 , 46 , 47 ] and aging on heat tolerance and psychophysiological adaptation during work in hot-dry and hot-humid environmental conditions. This is especially crucial since elderly workers [ 38 , 40 , 43 , 44 , 46 , 47 ] display increased susceptibility to HRI in future studies, even if they haven’t engaged in prolonged or strenuous physical labor [ 31 ]. Pogačar et al.‘s study revealed that the most common symptoms of heat stress include excessive sweating, thirst, and fatigue. Interestingly, there was a significant difference among age groups regarding thirst and excessive sweating [ 35 ]. Gender differences in temperature regulation become more apparent under varying heat loads [ 8 ]. In general, women lose more heat through convection [ 11 ], which is advantageous in hot-humid environments [ 57 ], while men lose more heat through evaporation, which is more pronounced in hot-dry environments [ 58 ]. The resilience of vulnerable worker groups to heat stress can be compromised despite existing standards and knowledge. This vulnerability is particularly relevant when considering outdoor workers exposed to different climate conditions in tropical and subtropical countries [ 12 , 38 , 47 ]. Kjellstrom et al.‘s study underscores that mine workers remain the most significant population in terms of preventing the impact of thermal stress. This also extends to many construction workers, agricultural workers, and individuals laboring in warm workplaces without effective cooling systems [ 20 ]. Lui et al. demonstrated that wildland firefighters experience heat acclimatization across the thermal stress and fire season, leading to significant decreases in physiological and perceptual responses. These adaptations can reduce the risk of HRI [ 32 ]. Implementing acclimatization [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 47 ] and adaptation programms [ 13 , 48 , 49 ] for workers exposed to thermal stress is crucial. Adaptation policies aim to increase climate change resilience and reduce climate vulnerability [ 48 ]. Managers and occupational health professionals should also assess workers’ health status and individual habits, such as sleep deprivation [ 33 , 34 , 40 , 47 ], dehydration, and alcohol consumption before work [ 34 ]. International agencies have proposed various climate change adaptation and prevention strategies, including conducting training and awareness programs, using cooling mechanisms [ 13 , 16 , 26 , 38 , 39 , 40 , 41 , 44 , 47 ], and ensuring the availability of cool drinking water [ 13 , 16 , 20 , 25 , 44 , 47 , 49 ]. The most effective solutions at mitigating occupational heat strain were heat acclimation [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 47 ], wearing specialized cooling garments [ 27 , 47 ], cold water immersion [ 59 ], improving aerobic fitness [ 15 ], and applying ventilation [ 49 ]. Extending the exposure time to thermal stress leads to an increase in core body temperature and dehydration levels [ 60 ]. Acclimatized workers, with beneficial physiological adaptations like an efficient sweating system, lower heart rate, and core body temperature, can tolerate higher levels of dehydration and lose more water through sweat per shift. This means that the maximum allowable exposure time is greater for acclimatized workers compared to non-acclimatized workers [ 38 , 42 , 47 ]. Venugopal et al. demonstrated a strong correlation between physical workload, thermal stress exposures, Heat Strain Indicators (HSIs), and HRIs, leading to adverse health outcomes among outdoor workers [ 46 ]. There is a pressing need for evidence-based reviews and interventions to prevent occupational heat stress and enhance comprehensive resilience labor policies for outdoor workers in low and middle-income countries as climate change progresses. Increased awareness and consciousness among workers can lead to better adaptability to climate change risks [ 31 ]. Workers often implement conscious and flexible behavioral attitudes to manage their heat stress, especially in extremely hot workplaces, such as outdoor work [ 49 ]. Understanding the relationship between endurance time and WBGT values is crucial for training workers in very hot environments and ensuring their health and safety [ 43 ]. Elevated carbon emissions in the atmosphere contribute to extremely hot environments and climate changes, exacerbating occupational heat strains for outdoor workers [ 61 ]. A high-quality air and work environment can enhance worker safety, health, productivity, and company profitability [ 37 , 49 ]. Sustainable adaptation to warming climatic conditions [ 13 ] and social protection strategies during exposure to occupational heat stress depend on the availability of financial resources and collaborative efforts to overcome adaptation barriers [ 48 ]. The severity of occupational heat stress caused by climate change depends on workers’ sensitivity and vulnerability to different weather conditions. Additionally, the extent of adaptation capacity and resilience planning plays a crucial role [ 33 , 38 ]. Also, establishing a program that can assess how thermal stress due to climate change may increase heat-related effects on outdoor workers and document future heat-related events leading to relevant occupational health and safety regulations, seems essential [ 15 ].

The HEAT-SHIELD project is a customized occupational heat stress-related warning system that provides short- and long-term heat warnings to safeguard workers’ health and productivity. This project represents a useful adaptation strategy aimed at protecting workers, particularly those exposed to the effects of climate change [ 55 , 62 , 63 , 64 , 65 , 66 ].

The findings of this study are valuable for policymakers and professionals in the field of occupational health. They can use this information to develop guidelines and regulations aimed at preventing occupational heat stress and strengthening the resilience of outdoor workers during exposure to heat stress caused by climate change. However, it’s important to note that developing countries face a higher risk of negative occupational health outcomes compared to developed countries due to their lower adaptive capacity [ 46 ], increased poverty, and insufficient technological progress to combat climate change-induced temperature increases [ 6 , 47 ]. Outdoor workers often lack awareness of heat-related risks and HRI due to global warming [ 67 , 68 ]. Therefore, there is a critical need to raise awareness of heat-related hazards, bolster heat stress education, and update existing heat prevention measures. This includes optimizing current heat-related laws and adaptation policies to ensure effective implementation and compliance, especially in hot-dry and hot-humid work environments, particularly in low-middle-income countries [ 44 , 48 ]. Studies of this nature are essential among workers in these countries to provide health professionals and senior managers with the necessary knowledge to inform occupational heat stress adaptation policies, social protection measures, and resilience strategies for sustainable development.

Limitations

One limitation of this systematic review was the limited focus on female workers. Consequently, the results may not accurately represent the perspectives of women working outdoors, which is an important demographic to consider. Another significant limitation of this study is its heavy reliance on cross-sectional and experimental studies. Incorporating clinical aspects into data collection could greatly enhance and advance occupational health interventions. Furthermore, there is an evident scarcity of research exploring the social dimensions and the broader effects of occupational heat stress. Additionally, there is insufficient investigation into the adaptation strategies employed by workers in the context of increasing thermal stress and climate change, particularly in tropical and subtropical countries. These research gaps highlight the need for further studies to provide a more comprehensive understanding of this critical occupational health issue.

Addressing the health risks associated with occupational thermal stress among outdoor workers requires a multi-level approach that includes standard procedures and safety interventions. Currently, there is a lack of formal guidelines for outdoor workers, and most advisory systems do not adequately support this workforce in implementing solutions to mitigate occupational heat stress and enhance climate change resilience. While many workers acknowledge the importance of increased hydration and clothing adjustments during hot-dry and hot-humid climate conditions, a smaller proportion attempt to modify the nature of their work or seek rest in cooler areas. It is crucial to recognize that occupational heat stress remains a prevalent issue among these populations. To address these challenges, we recommend conducting further research to enhance our understanding of strategies aimed at bolstering the resilience of outdoor workers against heat stress resulting from climate change. This research should encompass diverse fields such as medicine, climatology, occupational health, and epidemiology. Additionally, there is a need to improve information dissemination, develop relevant regulations, and implement protective strategies among outdoor workers. These efforts will aid in identifying and preventing heat stress-related policies, including mitigation and adaptation measures.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on request.

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Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Peymaneh Habibi & Farank Mahdavi

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Jaleh Razmjouei

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Exploring hot topics and evolutionary paths in the Diagnosis-Related Groups (DRGs) field: a comparative study using LDA modeling

• Xinrui Chen 1 ,
• Meng Zhang 1 ,
• Qingqing Bu 1 ,
• Peng Peng 1 ,
• Yilin Zhou 1 ,
• Yuqin Tang 1 ,
• Xiaoqin Tian 1 &
• Dan Deng 1  

BMC Health Services Research volume  24 , Article number:  756 ( 2024 ) Cite this article

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Metrics details

This study reviews the research status of Diagnosis-related groups (DRGs) payment system in China and globally by analyzing topical issues in this field and exploring the evolutionary trends of DRGs in different developmental stages.

Abstracts of relevant literature in the field of DRGs were extracted from the China National Knowledge Infrastructure (CNKI) database and the Web of Science (WoS) core database and used as text data. A probabilistic distribution-based Latent Dirichlet Allocation (LDA) topic model was applied to mine the text topics. Topical issues were determined by topic intensity, and the cosine similarity of the topics in adjacent stages was calculated to analyze the topic evolution trend.

A total of 6,758 English articles and 3,321 Chinese articles were included. Foreign research on DRGs focuses on grouping optimization, implementation effects, and influencing factors, whereas research topics in China focus on grouping and payment mechanism establishment, medical cost change evaluation, medical quality control, and performance management reform exploration.

Conclusions

Currently, the field of DRGs in China is developing rapidly and attracting deepening research. However, the implementation depth of research in China remains insufficient compared with the in-depth research conducted abroad.

Peer Review reports

Owing to an aging population, medical innovation, and rising health needs, countries face increasing medical demands and rapidly growing service costs. Controlling medical expenses, conserving health resources, and providing affordable, high-quality medical care have become urgent problems for public hospitals [ 1 ]. To solve this practical problem, in the 1970s, diagnosis-related groups (DRGs) were established in the USA [ 2 ]. DRGs prioritize clinical similarity and consider resource consumption, grouping cases by disease severity, diagnosis complexity, treatment mode, and resource consumption to set payment standards [ 3 ]. As a refined medical payment tool, its appearance is conducive to protecting the rights and interests of patients, hospitals, and medical insurance. It can effectively meet the requirements of health expenditure control, hospital management, and medical resource allocation [ 4 ]. Therefore, different countries have developed and implemented adapted versions based on the payment method of DRGs in the USA and have achieved results in controlling medical expenses [ 5 , 6 , 7 ]. Since the late 1980s, China has introduced DRGs to control medical expenses and reduce patient burdens [ 8 ]. After more than 30 years of localization development and pilot programs, DRGs have proven effective in managing insurance fees, resource use, and medical quality [ 9 , 10 ].

As medical insurance payment system reforms deepen, scholars worldwide are exploring diverse topics, generating new ideas, and proposing innovative theories and methods. DRGs in China started relatively late. Therefore, the overall quality of the papers published is lower compared to those from developed countries. Problems such as limited research scope, insufficient method innovation, and considerable homogenization persist [ 11 ]. Therefore, exploring the development status and research prospects of DRGs in China based on foreign research experiences is crucial. To this end, numerous researchers have extensively reviewed the literature on DRGs based on bibliometric tools such as CiteSpace and VOSviewer. They have also summarized the research directions in DRGs worldwide through keyword clustering [ 12 , 13 ]. However, this method is limited to keywords, authors, and research institutions and cannot visually analyze the overall content of the text. Moreover, for documents with unclear semantic relations and a rough logical structure, keyword clustering can easily ignore the main keywords [ 14 ]. Latent Dirichlet Allocation (LDA) effectively addresses this problem by leveraging text information to enhance semantic keyword associations within mined topics [ 15 ]. However, few studies have applied the LDA topic model to the literature analysis of DRGs. Therefore, this study comprehensively reviews the Chinese and international literature on the DRG payment system since its implementation. Using the LDA topic model, it identifies hot topics and developmental trends, drawing on international experiences to support DRG implementation in China.

Source of data

The data sources for this study included the Web of Science (WoS) and China National Knowledge Infrastructure (CNKI). The WoS database encompasses diverse multidisciplinary, high-impact, international, and comprehensive academic journals. It ensures the representativeness and authority of the literature sources [ 16 ]. Considering its highest applicability to the LDA topic model, it was used as the database for this study [ 17 ]. CNKI is the largest and most comprehensive Chinese literature database, covering more than 99% of Chinese academic and practical journals. It ensures the representativeness and authority of the literature sources [ 18 ]. Both databases serve as effective tools for bibliometric analysis. Therefore, this study selected the WoS and CNKI databases as the data sources for English and Chinese literature, respectively. The following search strategies were employed: Topic = (“Diagnosis Related Groups”) OR Topic = (“Diagnosis Related Group”) OR Topic = (“Diagnosis-Related Groups”) OR Topic = (“Disease Related Group”) OR Topic = (“casemix”) OR Topic = (“case-mix”), Document Types = Article; Language = English, Indexes = Web of Science Core Collection (WoSCC) for English literature. Non-research literature and review articles such as conference notices, news reports, industry trends, policy documents, literature with incomplete data, and literature with unavailable full texts were excluded. Literature related to other professional terms with the same abbreviation “DRG,” such as Dorsal Root Ganglion, Digital Raster Graphics, and Dynamic Route Guidance System, was excluded. The cut-off date for data retrieval was April 12, 2023. A total of 6,758 and 3,321 English and Chinese articles, respectively, were screened.

The literature screening was independently conducted by two reviewers, who retrieved a literature record based on inclusion and exclusion criteria. Disagreements were resolved through consensus, and in cases of persistent differences, a third reviewer was consulted to assess and make a final decision. Furthermore, data collection from each screened literature record was independently conducted by two reviewers. A third reviewer then assessed the completeness and accuracy of the extracted data.

Research method

We retrieved relevant literature on DRGs from the WoS Core and CNKI databases. We used the abstracts of the literature as text data. We preprocessed the text data by incorporating keyword information and removing stop words. We applied the LDA topic model to explore textual topics, identify hot topics in the field based on topic strength, and analyze the evolutionary trends of topics by calculating the cosine similarity between adjacent-stage topics. The specific steps are as follows:

Text preprocessing

We standardized and supplemented the exported bibliographic data and built a custom dictionary and stop-word list. We segmented the abstract text, replaced synonyms, removed stop words, and built a dictionary and corpus according to the bag-of-words model. Among them, the self-defined dictionary was derived from the keywords included in this study: Stanford University stop list [ 19 ], Harbin Institute of Technology stop list, Baidu stop list [ 20 ], and NLTK stop list [ 21 ] were used for the summary of the stop list. The stop list was supplemented according to the pre-segmentation results to remove words with high word frequency but no practical meaning. Chinese and English word segmentations use the Jieba and NLTK modules in Python, respectively, to segment the abstract text based on the custom dictionary in precise mode. Simultaneously, the term frequency-inverse document frequency (TF-IDF) algorithm is used to extract text features, and the importance of each term in the document is quantified to verify keyword relevance in the corpus [ 22 ] to improve the accuracy and interpretation of the topic model.

LDA topic model

LDA, first proposed by Blei et al. [ 23 ], is a probabilistic topic model that identifies hidden semantic structures in unstructured text for topic abstraction and clustering. The model comprises a three-layer Bayesian network structure of “document-topic-word,” where documents include several topics. Each topic comprises a specific set of words from the document, and each word in the document is associated with a certain probability distribution. Thus, the topic of a document can be represented by the group of words with the highest probability of occurrence [ 24 ]. Thus, this model obtains the document situation of a specific topic in the DRG domain through “document-topic probability distribution.” It obtains the potential topic and word distribution of different topics in the DRG domain through “topic-word probability distribution,” [ 25 ] thereby calculating the semantic relevance between topics and documents and between topics and words. The study utilizes the Gensim library in the Python language to construct a topic model. After debugging and validation, the hyperparameters α and β are set to 0.1 and 0.01, respectively, with 1000 iterations and 5 passes over the corpus. The resulting topic model, under these settings, ensures sufficient training and convergence while possessing good robustness and generalization capabilities.

The LDA topic model must set the number of topics in advance, and the common method is to calculate the topic perplexity and coherence [ 26 ]. The degree of confusion [ 27 ] measures the quality of a probability distribution or probability prediction sample and determines the optimal number of topics. The smaller the degree of confusion, the more stable the topic structure of the model is and the less topic uncertainty there is. Topic consistency [ 28 ] is used to describe the distribution distance between different topics. We used the sliding-window-based coefficient of variation (CV) method to calculate the consistency. The higher the score, the higher the discrimination between topics and the better the clustering effect of the model. We used perplexity and coherence score metrics, along with visual analysis, to select the optimal number of topics, aiming for low perplexity and high coherence scores.

Confusion is calculated as follows:

where D is the document set, exp{} is an exponential function with the natural logarithm e as the base, \(\mathbf{p}({\mathbf{w}}_{\mathbf{d}})\) is the generation probability of document d, \({{\varvec{N}}}_{{\varvec{d}}}\) represents the lexical length of document d, and M is the number of documents.

The consistency score is calculated as follows:

Here, V is a set of words describing the topic, and \({\varvec{\upepsilon}}\) returns a smoothing factor for the real number to guarantee the score.

Thematic similarity

Topics in similar developmental stages often exhibit high similarity in the evolutionary process, and the evolutionary relationships between different topics can be identified by extracting topics with high similarity. The cosine similarity is a widely used measure that assesses the similarity between topics by measuring the angle between two vectors, thereby determining the degree of correlation and evolutionary path of topics [ 29 ]. The range of cosine values was [0, 1]. The closer the cosine value is to 1, the higher the similarity of the topic vector, and vice versa. Based on existing related research, the average cosine similarity of adjacent temporal topic stages is used as a threshold, where if the cosine value between two topics is greater than the mean, it is considered that there is an evolutionary relationship between the two topics [ 30 ]. The cosine similarity is calculated as follows:

Here, Ai and Bi are vector representations of the two topics A and B.

Thematic intensity

Topic intensity is the degree of attention paid to a topic in a certain period, and its expression is the number of documents containing the topic. The greater the topic’s intensity, the more likely it is to be considered a hot topic.

The formula for calculating the theme intensity is as follows:

Here, \({{\varvec{T}}}_{{\varvec{k}}}\) is the intensity value of the topic k, and \({{\varvec{\theta}}}_{{\varvec{k}}}^{{\varvec{d}}}\) is the probability of the topic k appearing in the document d.

Time and geographical distribution

Time distribution.

Since the late 1970s, DRGs have predominantly been studied abroad. With the implementation of DRGs in an increasing number of countries and regions, the number of related studies is also increasing annually. According to the trend in the literature quantity distribution curve, the development of foreign DRGs can be divided into four stages: exploration stage (1979–1990), embryonic stage (1991–2002), development stage (2003–2013), and maturity stage (2014–2023). The number of published articles has shown a steady growth trend overall, and research in the field of DRGs in developed countries has matured. In the late 1980s, China introduced the concept of DRGs to control unreasonable growth in medical expenses and reduce the medical burden on patients. According to the number of papers published, the development of DRGs in China can be divided into three stages: the initial trial period (1985–2005), the active exploration period (2006–2015), and the rapid development period (2016–2023). Figure  1 shows the trend in the number of annual publications of DRG-related literature, both in China and internationally.

Annual trend of diagnosis-related group (DRG) publications in Chinese and international contexts. Note: The study data search deadline was April 12, 2023. Therefore, the literature data for 2023 were incomplete

Geographical distribution

Figure  2 shows the number of publications issued by countries worldwide. Research in the field of DRGs has primarily been conducted in developed countries and concentrated in the USA and Europe. The top five countries in terms of the number of publications were the USA, UK, Canada, Netherlands, and Germany. Among them, the USA is the origin of payment according to the disease diagnosis group and takes the lead in applying DRGs to the settlement process of hospitalization expenses, becoming the leading country in the field of DRGs, and its number of publications far exceeds that of other countries. The global proportion of articles published by China is only 2.69%. There is still much room for development in this field, and international influence needs further improvement.

Top 10 countries for DRG-related research and number of publications

Figure  3 shows a visual analysis of the regions to which documents are sent in China. Therefore, research in the field of DRGs is mainly concentrated in eastern coastal areas, such as Beijing, Shanghai, and other economically developed areas. Among these, Beijing, the leading city in the development of DRGs in China, has the largest number of publications. Note that the number of publications issued in Xinjiang is outstanding, and the reform of medical and health systems and high-quality development in western China are effective.

Regional distribution of the number of DRG-related publications in China

Topic extraction and analysis based on LDA topic model

Determination of the optimal number of topics.

The optimal number of topics was selected by combining the confusion and consistency scores, and the number of topics with smaller confusion and larger consistency scores was selected by combining the visualization results. Taking Chinese literature as an example, we selected an integer within the range of 1 to 20 as the number of potential topics and calculated the corresponding topic confusion and consistency scores, as illustrated in Fig.  4 A. When the number of topics K = 8, the degree of confusion is relatively low and the consistency score is relatively high, and both have obvious inflection points. Therefore, the number of topics K = 8 was selected as the optimal number of topics for the entire cycle of Chinese literature. Similarly, according to Fig.  4 B, C and D, the optimal numbers of topics for 1985–2005, 2006–2015, and 2016–2023 were determined to be K = 6, K = 6, and K = 8, respectively. Similarly, it can be determined that the optimal number of topics for the full period and each period of the English literature is K = 6, K = 5, K = 8, K = 5, and K = 6, respectively.

A Determination of the optimal number of topics over the entire period. (a) Perplexity Score; (b) Coherence Score. B Determination of the optimal number of topics over the initial trial period. (a) Perplexity Score; (b) Coherence Score. C Determination of the optimal number of topics over the active exploration period. (a) Perplexity Score; (b) Coherence Score. D Determination of the optimal number of topics over the rapid development period. (a) Perplexity Score; (b) Coherence Score

Topic content analysis

Based on the modeling results of LDA topics, several topics have been studied in the field of DRGs in China and internationally, and the word distribution of each topic can be obtained, namely, “theme-vocabulary probability distribution.” The top 10 featured words with high probability under each topic were sorted and summarized according to the featured words to summarize the topic name and form a topic list in the field of DRGs research.

Among them, the six topics in the English literature were payment systems and cost analysis, effect evaluation and performance management, disease mortality and status assessment, case grouping based on disease severity, internal medicine nursing and quality control, surgical procedures, and operating room management. Table 1 presents the topic summary and subject keywords. The eight topics in the Chinese literature were payment mechanisms, medical expenses, the front sheet of medical records, reform background, performance management, medical service, clinical pathway, and effectiveness evaluation. The topic summary and subject keywords are presented in Table  2 .

Hot topics analysis

Based on the LDA topic mining results, the probability of topic k appearing in document d can be obtained, namely “document-topic probability distribution,” which represents the probability distribution of each topic in each document. The larger the probability value, the more likely it is that a document belongs to this topic. The topic intensity corresponding to each topic category is calculated according to the document-topic probability distribution, as shown in Fig.  5 . The red dotted line is the average intensity of each topic, and the topic with a topic intensity higher than the average intensity value is a hot topic in the DRG field. The figure shows that the hot topics in the field of DRGs abroad are Topic1 (payment system and cost analysis), Topic5 (internal medicine nursing and quality control), and Topic6 (internal medicine nursing and quality control), while those in China are Topic1 (payment mechanism), Topic4 (reform background), Topic5 (performance management), Topic7 (clinical pathway), and Topic8 (effectiveness evaluation).

Histogram of topic intensity corresponding to each topic category. a English literature; b Chinese literature

Analysis of theme evolution path

After LDA topic modeling was performed on the literature at each stage, the cosine similarity between topics in adjacent time stages was calculated. Based on the cosine similarity with the evolutionary relationship, a Sankey diagram of topic evolution was drawn, as shown in Fig.  6 . The evolutionary path and logical relationship between topics were obtained. The horizontal axis represents each stage of DRGs’ development in China and internationally; the vertical axis represents topics at different development stages; and the connecting line develops from left to right. The thickness of the line between rectangular blocks represents the similarity of topics. The thicker the line between different topics, the higher the similarity, and the stronger the evolutionary relationship between topics.

Sankey diagram of topic evolution. a English literature; b Chinese literature

The payment system for disease DRGs is a type of homogeneous case-planning based on disease diagnosis and operation. Its practical application controls medical expenses and improves the medical environment. Global research into DRGs continues to increase. After the reform of payment modes in China, the quantity and quality of DRG-related research have increased drastically; however, there is still a gap compared with developed countries. Based on the above results, the following conclusions can be drawn:

DRG research in China has developed rapidly, but regional development remains uneven

Globally, English literature on DRGs was published earlier than Chinese literature, and the number of published articles generally showed an increasing trend. In the 1970s, Robert B. Fetter and John D. Thompson of Yale University in the USA pioneered the design and development of the payment system for DRGs [ 31 ], marking the historic milestone of case-based payment based on clinical and resource consumption similarity. The DRGs payment system entered an “exploration stage.” Since the 1990s, most high-income countries have adopted the DRGs payment method as the primary means of reimbursing hospital acute inpatient expenses. Building upon the USA DRGs, countries have successfully explored reforms adapted to their own DRG systems [ 32 , 33 , 34 ], ushering DRG development into an “embryonic stage.” Additionally, Liu [ 35 ] has elucidated the sudden surge in literature volume in 1991 based on database constraints. Subsequently, the literature volume has steadily increased, aligning with Liu et al.’s observations [ 36 ]. Furthermore, with expanded patient coverage, new medical technologies, and standardized diagnosis and treatment coding, the USA has developed a medical payment system based on an international single-disease grouping system. DRGs have thus been promoted globally as a revolutionary means of medical quality management and cost reimbursement [ 37 ], entering a “development stage.” In recent years, the number of studies has stabilized, indicating that research on DRGs in developed countries has reached a “maturity stage” [ 38 ]. China began to focus on DRGs in the 1980s and made its first attempt at a large-scale DRGs pilot study in hospitals in Beijing. However, given the relatively backward informatization in China at that time, no unified electronic medical record was established. Additionally, information data could conduct DRG-related research [ 39 ]; therefore, the number of DRG studies was low, and this was the “initial trial period.” In 2006, China’s DRG system began to conduct localization development and advocated that regions with conditions could gradually explore the method of payment by disease groups. The advance of network technology, standardization of electronic medical records, and policy formulation have fostered the development of DRGs [ 40 ]. The number of DRGs issued showed an initial increasing trend, called an “active exploration period.” In 2016, China began to issue guidance on deepening the reform of basic medical insurance payment methods at the national level, as well as the CHS-DRG version of disease diagnosis-related grouping based on China’s national conditions, and took 30 cities as the national pilot for DRG payment. DRGs began to enter the actual payment stage [ 41 , 42 , 43 ], during which the number of DRGs issued in China significantly increased, called a “rapid development period.”

Research on DRGs in China is primarily distributed in the eastern coastal areas, which may be because DRGs were first piloted in Beijing once they were introduced into China. The information technology development in Beijing, Shanghai, Guangdong, and other first-tier cities occurred earlier, and the flow of scientific research institutions and talent was more concentrated. Therefore, more relevant literature existed. In contrast, owing to the relatively backward information level, insufficient supply of medical resources, and uneven distribution of talent in western China [ 44 ], the amount of DRG research literature is relatively small. However, compared with other provinces and cities in the west, Xinjiang has a relatively large number of papers, which may be because it covers one-sixth of the total area of China. Its strategic position and geographical advantages are more prominent, making it representative of the western region [ 45 ]. Among them, Urumqi City, an early pilot city of national payment according to disease DRGs, performed the actual payment of DRGs in six local hospitals. Therefore, the research effect in Xinjiang requires attention.

DRGs’ wide range of research topics in China and insufficient research depth

The LDA topic modeling shows that foreign countries also focus on the difficult problems of diseases and fields not covered by DRGs based on the payment policy environment of DRGs. The topics include influencing factors and optimization suggestions for DRG group payment based on the severity of diseases, medical disease nursing, and surgical operations, as well as research on DRGs of nursing home versions, DRGs of home care versions, and DRGs of long-term care [ 46 ]. Chinese research has primarily focused on exploring and applying DRG reform background analysis, payment mechanism research, cost accounting, implementation effect evaluation, medical quality management, and other topics. Simultaneously, to continuously strengthen medical quality, standardize medical behavior, and save medical resources during DRG implementation, clinical pathway management, quality control of medical record first page and coding operation, selection of performance appraisal indicators, and other topics have also attracted attention. This may be due to moral hazard behaviors such as high coding problems, patient selection problems, inhibition of new technology and business, and investment reductions in disease prevention and health promotion [ 10 , 47 ]. Research on DRGs in China is progressing; however, compared with the mature experience abroad, China prefers to study the theoretical framework and practical exploration of DRGs as a whole. China lacks refined research on the DRG implementation path from a disease perspective. Research on quality control in the operation process of DRGs is not mature. Therefore, the overall implementation depth is insufficient, and the research field must be expanded.

Additionally, the subject intensity shows that the research hotspots of foreign scholars in the field of DRGs focus on care quality for specific diseases in surgery, the impact of surgical procedures on DRGs, and cost analysis and payment system research on DRGs. However, research hotspots in China focus on mechanism analysis, hospital management, and effect evaluation. Difficult problems such as accurate case grouping of various diseases, continuous innovation of payment modes, and efficient evaluation of medical services require further studies. Yin Yani [ 48 ] confirmed this conclusion.

Development progress of DRGs and ongoing long-term exploration stage

The literature evolution Sangji diagram shows that, after the short-term methodological research, foreign countries began applying DRGs to medical nursing and surgical operations. DRGs were optimized based on indices such as disease severity and patient survival status, and DRGs were used in hospital management, cost analysis, cost control, efficiency evaluation, and quality management. After a long period of development and innovation, DRG-related research has almost reached maturity. However, the research on DRGs in China has experienced the development path of “basic theory-practical application-quality control,” which is consistent with the results of Liu [ 49 ] on the evolutionary history of DRGs in developing countries. Early research focused on basic theory, exploring DRGs in developed countries such as the United States, prepaid mechanisms, and proposing a group payment strategy suitable for China. In the middle stage, most studies were practical explorations and comparative analyses. China has begun to conduct application research on DRGs, focusing on hospital pilot research, medical insurance system reform, payment mode comparisons, and implementation effect evaluations. Among them, the negative impact of implementing DRGs has attracted the attention of many scholars. Therefore, research on quality evaluation and clinical pathways has gradually increased in this stage to strengthen the standardized management of medical diagnosis and treatment processes. In recent years, China has begun to conduct DRG hospital management and quality control-related research, including performance management, medical record first page, and path optimization.

From the evolutionary path of the development of DRGs, DRGs research in China is becoming increasingly improved; however, it remains in the long-term reference and exploration stages. The challenges posed by implementing DRGs to healthcare quality continue to warrant attention. Gu [ 50 ] believed that the payment mode of DRGs in China is only in the experimental stage and that the healthcare supply system lacks sufficient governance structure and incentive measures. This indicates that a management system that is more suitable for national conditions in the pilot process of DRGs must be found. Simultaneously, topics related to expenses run through the entire path cycle. Combined with the rapid development of the level of medical services in China, controlling medical expense growth has become the core goal and research focus of DRGs. Li [ 51 ] reached a similar conclusion in their review; that is, the main research content of DRGs in China is medical expenses. Thus, Chinese research should analyze the factors influencing medical expenses based on the DRG payment system. The results of the research hotspots and theme evolution paths show that research trends in DRGs will focus on medical quality management, cost control effect evaluation, accurate case grouping, and implementation path optimization.

The above conclusions show that after the pilot and application of the DRGs payment mode in China, research has made breakthroughs. However, compared to its overall promotion and application in developed countries, it faces challenges. Therefore, China should strengthen cooperation between Chinese and international academic institutions, understand the latest research results and practical experience, and actively explore and implement a payment system adapted to its own national conditions. China should further optimize the allocation of medical resources, improve the quality and efficiency of medical services, realize the reform and innovation of medical insurance payment methods, and provide assistance for popularizing and applying DRGs in China. The details are as follows:

First, the resources of all regions are balanced, and effective coverage of the reform of payment methods is achieved. DRG pilot areas should be extended from the national to the interior level. DRG management mode and reimbursement standards should be formulated in line with actual regional conditions according to the economic conditions and epidemiological characteristics of each region. Provincial reform pilots paid by DRGs should be promoted, and the regional coverage rate of DRG reform should be improved. Simultaneously, multi-party cooperation should be strengthened among government departments and medical institutions at all levels. Special DRG working groups, or expert advisory committees, should be established. Meetings, seminars, and experience-exchange activities should be regularly organized. Information sharing, communication, and DRG research and application should be promoted nationwide.

Second, departmental linkage is strengthened, and the research depth is improved in the DRG field. Considering the key and difficult problems in implementing DRGs, while continuously expanding the research field, research on implementing DRGs should be refined to ensure the accuracy and applicability of DRGs in different disease fields. Simultaneously, through the coordination and cooperation of health departments, financial departments, medical insurance departments, and other departments, the coordinated promotion of system reform, payment reform, performance reform, and revenue reform forms policy integration and optimal allocation of resources and realizes the deep integration of multiple reform achievements based on the linkage of medical treatment, medical insurance, and medicine.

Third, theory is combined with practice to promote high-quality medical reform. Scientific, transparent, and operable theoretical frameworks are formulated and improved, such as the DRG classification standard, cost weight calculation method, and clinical pathway management guide; providing operational guidance for the quality control of medical institutions; and promoting fine management and operational efficiency improvement in hospitals. Simultaneously, aiming at the difficulties and problems in the practice process, such as medical data collection, filling in the first page of medical records, and weight calculation rules, we will provide corresponding training, consultation, and technical support to help medical institutions fully understand and reasonably apply the DRGs system and provide an empirical basis and improvement direction for theoretical research. Additionally, a high-quality, strict monitoring and evaluation system should regularly evaluate the impact of DRGs, identify problems, and make timely improvements to inform policy adjustments and enhance DRG application in China’s medical system.

We analyzed the time and regional distribution of Chinese and international publications by comprehensively searching Chinese and English databases. We used the LDA model to mine potential topics in Chinese and international DRGs. We also summarized the hot topics of DRG research based on the calculation of topic intensity. We analyzed the evolution path and research trend of DRGs development based on the calculation of cosine similarity between topics. It is a reference for in-depth research and future research on DRGs. In DRG development abroad, the research hotspots primarily focused on exploring DRGs, related research under the payment policy environment, and uncovered fields of DRGs. In contrast, the Chinese research started late, primarily focusing on basic theory research and foreign experience and then gradually turning to practical exploration and comparative analysis research. In recent years, Chinese research has focused mainly on hospital management and quality control. In the future, Chinese research should focus on the quality of medical care during the implementation of DRGs and analyze the influencing factors of medical expenses from the perspective of DRGs. Future research should also explore related fields such as cost control effect evaluation, accurate case grouping, and clinical pathway optimization. Additionally, DRG optimization management should be strengthened for complex and high-risk diseases, as well as for special populations. This would promote DRG application and popularization in China. Strengthening academic exchange and cooperation, deepening coordination between medical insurance and relevant departments, and establishing a reform mechanism integrating research and practice will enhance China’s medical quality management, optimize resource allocation, control expenses, and contribute to global healthcare development.

Limitations

First, the literature sample was only selected from the WoS and CNKI databases. Although these databases are authoritative, several DRGs-related literatures published in other databases may still be potentially omitted. Therefore, future research should include additional databases. Second, regarding language, this study only included literature in Chinese and English. Future research should broaden language selections. Additionally, although the LDA model overcomes the one-sidedness of using journal literature keywords to mine research hotspots, this study only analyzed abstracts in the literature, and the topic tags were named according to the subject words and subjective judgment, lacking the participation of domain experts. Moreover, literature processing was performed manually, potentially leading to incomplete data collection and omissions.

Availability of data and materials

The datasets and analysis codes used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Diagnosis-Related Groups

Latent Dirichlet Allocation

Web of Science

Science Citation Index Expanded

China National Knowledge Infrastructure

Term Frequency–Inverse Document Frequency

Coefficient of Variation

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Acknowledgements

The authors would like to thank everyone who helped with this study.

This research was funded by Chongqing Municipal Science and Technology Bureau's Chongqing Talent Plan for 2022 (cstc 2022 ycjh-bgzxm 0015). And it was also funded by the Program for Youth Innovation in Future Medicine, Chongqing Medical University (W0063).

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Xinrui Chen, Meng Zhang, Qingqing Bu, Bo Tan, Peng Peng, Yilin Zhou, Yuqin Tang, Xiaoqin Tian & Dan Deng

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XC: Conception and design of the work, as well as manuscript writing; MZ, QB, and BT: Data analysis and interpretation; PP, YZ, YT, and XT: Data collection; DD: Critical revision of the article. All authors approved the final manuscript before submission.

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Chen, X., Zhang, M., Bu, Q. et al. Exploring hot topics and evolutionary paths in the Diagnosis-Related Groups (DRGs) field: a comparative study using LDA modeling. BMC Health Serv Res 24 , 756 (2024). https://doi.org/10.1186/s12913-024-11209-3

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Received : 30 October 2023

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DOI : https://doi.org/10.1186/s12913-024-11209-3

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