Diagnosis Related Group Case Mix Research Articles

Impact of the COVID-19 pandemic on acute mental health admissions in Croatia.

The pandemic of COVID-19 had a profound impact on our community and healthcare system. This study aims to assess the impact of COVID-19 on psychiatric care in Croatia by comparing the number of acute psychiatric cases before coronavirus disease (2017-2019) and during the pandemic (2020-2022). The paper is a retrospective, comparative analyzes of the hospital admission rate in Diagnosis Related Group (DRG) classes related to mental diseases, and organic mental disorders caused by alcohol and drug use. This study used DRG data from all acute hospitals in Croatia accredited to provide mental health care services and relevant publicly available data from the Croatian Institute of Public Health (CIPH) and the Croatian Health Insurance Fund (CHIF). All hospital admissions for acute psychiatric patients in Croatia were tracked during both periods under study. During the pandemic, the average number of all such cases decreased by 28% in secondary and tertiary hospitals, and by 11% in specialist psychiatric hospitals. It was also found that during COVID-19, there was a decrease in case numbers in DRG classes related to major affective disorders and anxiety, alcohol, and drug intoxication (31, 48, 34 and 45%, respectively). However, the same period saw an increase in hospital activity for eating disorders and for involuntary admissions related to schizophrenia and paranoia (30, 34 and 39% respectively). There were no changes in the admission rate for cases related to opioid use. The COVID-19 pandemic resulted in both a steep decrease in the overall number of psychiatric cases inpatient treatment at mental health facilities and their DRG casemix. Increasing our understanding of how pandemics and isolation affect demand for psychiatric care will help us better plan for future crises and provide more targeted care to this vulnerable group.

Case mixed method in a DRGs-based study of the hospitalization expenses of patients with cervical cancer

Objective To explore the case mixed method in diagnosis-related groups (DRGs) of patients with cervical cancer in Nantong and to provide references for standard hospitalization expense of cervical cancer. Methods 8 610 patients with cervical cancer from Nantong Tumor Hospital from 2006 to 2013 were selected for the study. The influencing factors of hospitalization expenses were screened by multiple liner regression. DRGs case mix scheme was established by Chi-squared automatic interaction dtector in the decision tree model. Results The mean hospitalization expense was 11 363 yuan and the median was 9 325 yuan. The influencing factors included admitting pathways, complications, therapeutic methods and prognosis of diseases. The cases of 8 610 formed 11 DRGs combinations, with the corresponding hospitalization expense standards. Conclusions Case-mix diagnosis related groups are reasonable. The standards and related weights of hospitalization expenses could serve references for hospitals and medical insurance institutions. Key words: Cervical cancer; Diagnosis-related groups; Decision tree; Hospitalization expense

Study on Diagnosis Related Groups of In-patient Expenses of Breast Cancer

AbstractObjective. To explore the DRGs case mix scheme of hospitalization expenses suitable for breast cancer patients in Xinjiang area. Methods. The case grouping was performed on 3,788 effective medical records of patients with the main diagnosis of breast cancer, from January 1, 2010 to December 31, 2012, by using the single factor analysis, Analysis Of Variance (ANOVA) and multiple linear stepwise regression methods; the samples were divided into case groups according to the main influence factors; and the standard expense of each group was calculated. Results. The main factors affecting the hospitalization expenses were, sequentially, the Length of Stay (LOS), whether the treatment undertaken was chemotherapy, surgery, or radiotherapy; the standard regression coefficients were respectively 0.557, − 0.312, − 0.284, and − 0.212; P < 0.01; and R2 = 0.826. The case mix hospitalization expenses were divided into five Diagnosis Related Groups (DRGs); there was statistical difference between the groups acco...

Study of designing the standard interval for hospitalization costs based on clinical pathway

Objective To set the cost standards for hospitalization based on the eases of the clinical pathway in order to help set a reasonable ceiling for the expenses of various diseases.Methods The multiple linear regression analysis was applied to find out influencing factors of hospitalization costs of the hysteromyoma.Diagnosis Related Groups(DRGs)ease mix was used to group 1777 hysteromyoma cases.Results The main factors for the expenses,as listed by their influence,were surgical operation or not,disease(s)of concomitance and the amount,adjusted R2 =0.6545.Hysteromyoma patients were divided into four diagnosis related groups; the all coefficient of variation(CV)is as small as 0.068,0.104,0.102,and 0.116 respectively.The hospitalization costs of the hysteromyoma of standard reference value were then calculated.Conclusion The standards interval for hospitalization costs set with DRGs case mix is reasonable and efficient,significantly useful for regulating medical practice and harnessing excessive costs of hospitalization. Key words: Case mix; Diagnosis related groups (DRGs); Hospitalization costs; Clinical pathway

Valoración clinicoeconómica de un servicio de medicina interna-infecciosas en un hospital general universitario (2005–6)

Comparative study in patients with infectious diseases admitted to a specialized Internal Medicine-Infectious Diseases Department (IMID) versus those admitted to other medical departments in a university general hospital, investigating quality and cost-effectiveness. Analysis of patients in 10 principle diagnosis-related groups (DRGs) of infectious diseases admitted to the IMID were compared to those admitted to other medical departments (2005-2006). The DRG were divided in 4 main groups: respiratory infections (DGR 88, 89, 90, 540), urinary infections (DRG 320, 321), sepsis (DRG 416, 584), and skin infections (DRG 277, 278). For each group, quality variables (mortality and readmission rate), efficacy variables (mean hospital stay and mean DRG-based cost per patient) and complexity variables (case mix, relative weight, and functional index) were analyzed. 542 patients included in the 10 main infectious disease DRGs were admitted to IMID and 2404 to other medical departments. After adjusting for DRG case mix (case mix 0.99 for IMID and 0.89 for others), mean hospital stay (5.11 days vs. 7.65 days), mortality (3.5% vs. 7.9%) and mean DRG-based economic cost per patient (1521euro/patient vs. 2952euro/patient) was significantly lower in the group of patients hospitalized in IMID than the group in other medical departments (p<0.05). The readmission rate was similar in the 2 groups (5.5% and 6.5%, respectively). The results per each DRG group were similar to the overall results. For a similar case mix, hospitalization in IMID departments had a positive influence on the variables analyzed as compared to hospitalization in other departments, with a shorter mean stay, lower mortality, and lower mean DRG-based economic cost per patient. Creation and development of IMID departments should be an essential objective to improve healthcare quality and respond to social demands.

Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non-parametric methods.

The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (e.g., Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospital-specific and national DRG case-mix rates. Since implementation in 1990, the percentage of each hospital's budget based on hospital specific costs was to decrease, while the percentage based on DRG case-mix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospital-specific cost basis. While all other non-NHS third party payers are currently paying based on DRGs, the adoption of DRG case-mix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a two-stage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e., technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992-1994, using both parametric and non-parametric frontier models. We find evidence that the DRG payment system does appear to have had a positive impact on productivity and technical efficiency of some commonly employed diagnostic technologies in Portugal during this time span.

Case Mix and Resource Utilization by Uninsured Hospital Patients in the Boston Metropolitan Area

Rising competitive pressures may place uninsured patients at risk for receiving fewer services than insured patients with similar medical conditions. To examine this possibility we studied the case mix, length of stay, and number of procedures for 65,032 patients listed as self-pay or free care, Blue Cross, or Medicaid at 52 hospitals in the Boston, Mass, area during 1983. We found that the overall case mix severity index (based on expected length of stay per diagnosis related group) for uninsured patients was 30% higher in public hospitals and 8% higher in major teaching hospitals compared with other institutions. Across all hospitals, the severity index of uninsured patients was similar to that of insured patients. However, after adjusting for diagnosis related group case mix, uninsured patients had, on average, 7% shorter stays (5.36 vs 5.79 days) and underwent 7% fewer procedures (1.16 vs 1.25) than Blue Cross patients, the differences varying with hospital type. Uninsured patients also had shorter stays on average than Medicaid patients (5.36 vs 5.87 days), but they underwent a similar number of procedures. These results suggest that patients who lack insurance may receive unequal treatment even after being hospitalized.

Severity of illness within DRGs: impact on prospective payment.

This study compares the financial impact of a Diagnosis Related Group (DRG) prospective payment system with that of a Severity of Illness-adjusted DRG prospective payment system. The data base of about 106,000 discharges is from 15 hospitals, all of which had a Health Care Financing Administration (HCFA) DRG case mix index greater than 1. In order to pool the data over the 15 hospitals, all charges were converted to costs, normalized to Fiscal Year 1983, and adjusted for medical education and wage levels. The findings showed that, for the study population as a whole, DRGs explained 28 per cent of the variability in resource use per case while Severity of Illness-adjusted DRGs explained 61 per cent of the variability in resource use per case. When we simulated prospective payment systems based on DRGs and on Severity-adjusted DRGs, we found that the financial impact of the two systems differed by very little in some hospitals and by as much as 35 per cent of total operating costs in other hospitals. Thus, even with a data set that is relatively homogeneous (with respect to the HCFA DRG case mix index definition of hospitals), we found substantial inequities in payment when DRGs were not adjusted for Severity of Illness. These findings suggest that, with a more representative set of hospitals, the difference between unadjusted and Severity-adjusted DRG-based prospective payment could be greater than 35 per cent of a hospital's total operating costs.