Abstract
BackgroundAs soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to evaluate if nursing activity is homogeneous by APR-DRG and by severity of illness (SOI) (2) to evaluate the outlier’s rate associated with the nursing activity and (3) to compare nursing cost homogeneity per DRG and SOI.MethodsStudy done in 9 Belgian hospitals on a selection of APR-DRG with more than 30 patients (7 638 inpatient stays). The evaluation of the homogeneity is based on coefficients of variation (CV). The 75th percentile + 1.5 × inter-quartile range was used to select high outliers. 25th percentile −1.5 × inter-quartile range was used to select low outliers. Nursing costs per ward were distributed on inpatient stays of each ward following two techniques (the LOS vs. the number of nursing care minutes per stay).ResultsThe homogeneity of LOS by DRG and by SOI is relatively good (CV: 0.56). The homogeneity of the nursing activity by DRG is less good (CVs between 0.36 and 1.54) and is influenced by nursing activity outliers (high outliers’ rate: 5.19%, low outliers’ rate: 0.14%). The outlier’s rate varies according to the studied variable. The high outliers’ rate is higher for nursing activity than for LOS. The homogeneity of nursing costs is higher when costs are based on the LOS of patients than when based on minutes of nursing care (CVs between 0.26 and 1.46 for nursing costs based on LOS and between 0.49 and 2.04 for nursing costs based on minutes of nursing care).ConclusionsIt is essential that the calculation of nursing cost by stay and by DRG for hospital financing purposes was based on nursing activity data, that more reflect resources used in wards, and not on LOS data. The only way to obtain this information is the generalization of computerized nursing files.
Highlights
As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that diagnosis related groups (DRGs) were not very homogeneous with regard to nursing care
Homogeneity of the nursing activity by DRG and by SOI coefficients of variation (CV) were calculated by DRG and severity of illness
Outliers are more important for several DRG and SOI (Table 2), which means that there are large consumers of nursing care, even in a same DRG and a same severity of index. 27.02% of high nursing activity outliers are high length of stay (LOS) outliers. 71.97% of high nursing activity outliers are LOS inliers and 1.01% of high nursing activity outliers are low LOS
Summary
As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. Few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. The biggest part of the BMF is calculated on the basis of “All Patient refined diagnosis related groups” (APR-DRGs) through “justified” days, that means national length of stay (LOS) by disease. About 6.5% of the national budget is reserved for supplementing the BMF of each hospital with an additional budget allocation, partly based on nursing interventions data [2]. For this supplement, hospitals record nursing activity four times a year (4*15 days). The additional budget allocation is based on the number of inpatient days per zone and their weight [3]
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