201 DIAGNOSIS RELATED GROUPS: A COMPARISON OF PEDIATRIC INTENSIVE CARE AND NONINTENSIVE CARE PATIENTS

Abstract

The case mix for 2,403 pediatric intensive care (PICU) and 14,552 general ward patients (WARD) by Diagnostic Related Groups (DRGs) were examined for a three year period. Available data included length of stay (LOS) and mean charges (MC) within eight accounting categories for each DRG for PICU and WARd. A subset of 856 PICU and 2,222 WARD patients in 9 most common DRGs was examined for variations in LOS and MC per patient. While case mix by DRG was consistent over time for both groups, the PICU case mix differed significantly from that of the WARD (p<.001). After adjustment for inflation and for differences in case mix, the average LOS for the PICU was 10.7 days versus 6.1 for the WARD (p<.025) with a MC of $7,172 for PICU and $2,946 for WARD (p<.01). These differences increased over time. During the three year period, PICU average LOS increased by 4.9% (.5 days) while that of the WARD decreased by 29.4% (2 days). In addition, marked differences in LOS and MC between PICU and WARD were found within the 9 DRGs. We conclude that significant inhomogeneity exists between PICU and WARD in all indices of resource utilization. Combining the PICU and WARD populations for the purpose of setting target rates and projecting length of stay would strongly bias reimbursement protocols against the PICU population.