Effects Of Diagnosis Related Groups Research Articles

The Effect of Diagnosis-Related Groups on the Shift of Medical Services From Inpatient to Outpatient Settings: A National Claims-Based Analysis.

The purpose of this study was to determine whether the introduction of diagnosis-related groups (DRGs) shifted the medical services from inpatient to outpatient settings. Using a difference-in-difference analysis, the changes in length of stay, outpatient visit days within 30 days before hospitalization, and outpatient visit days within 30 days after hospital discharge were evaluated. The length of stay was reduced after the DRG policy, consistent with previous studies. Outpatient visit days within 30 days before a hospital admission increased significantly after the policy change. In addition, outpatient visit days within 30 days after a hospital discharge increased in all the medical institutions excluding hospitals. The study findings are consistent with the expectation that providers respond to changes in the payment system to protect or enhance their economic interests. Health care providers in Korea responded to the DRG policy by reducing the intensity of inpatient treatment and transferring costs to outpatient settings.

Patient-Centred Multidisciplinary Inpatient Care-Have Diagnosis-Related Groups an Effect on the Doctor-Patient Relationship and Patients' Motivation for Behavioural Change?

The aim of this, the largest survey of patients performed to date, is to analyse the effects of diagnosis related groups (DRGs) on the doctor-patient relationship in the context of interdisciplinary patient-centered care. In addition, it is intended to investigate the possibility of motivating patients to change their behavioural patterns and lifestyle in the context of holistic therapy. Over a period of five years, a continuous survey was performed of hospitalised patients who were exercising their entitlement to interdisciplinary therapy in an acute, inpatient setting. The therapy was evaluated as good to very good both with and without the conditions of the case tariff fee system. Effects of the diagnosis related groups on the quality of the doctor-patient relationship could not be demonstrated (Mann-Whitney U test, p>0,05). A clear trend was evident in the influence on motivation to change behavioural patterns and lifestyle (Fisher's exact test, p=0,000). Studies of the effects of reimbursement systems in the context of interdisciplinary care are still in their infancy, despite the widespread use of diagnosis related groups. The mandatory character implicit in the case tariff fee system, which requires minimum qualitative standards for structural and procedural parameters in the context of providing interdisciplinary patient-centered care, can influence patients' behavioural patterns and lifestyle.

Possible effect of DRGs on the classification of stroke: implications for epidemiological surveillance.

Accurate data on the distribution of stroke subtypes are essential for understanding the forces driving recent morbidity and mortality trends. The introduction of diagnosis-related groups (DRGs) in the 1980s may have affected the distribution of stroke subtypes as defined by International Classification of Diseases, Ninth Revision (ICD-9), discharge diagnosis codes. The Pawtucket Heart Health Program cardiovascular surveillance data were used to examine trends in stroke classification for 1980 to 1991 in relation to the introduction of DRGs in 2 communities in Massachusetts and Rhode Island, where DRGs were implemented 2 years apart. Included were all hospital discharges for residents aged 35 to 74 with a primary ICD-9 diagnosis of 431 to 432, 434, or 436 to 437 (N=1386 in Rhode Island, N=1839 in Massachusetts). In each state, concurrently with the introduction of DRGs, the proportion of strokes classified as cerebral occlusion (ICD-9 434.0 to 434.9) increased, and the proportion classified as acute but ill-defined (ICD-9 436.0 to 436.9) decreased. Before DRGs, 30.0% of strokes in Rhode Island and 26.6% in Massachusetts were classified as cerebral occlusion, whereas 51.8% in Rhode Island and 51.7% in Massachusetts were classified as acute ill defined. After DRGs were instituted, the proportions of cerebral occlusion and acute, ill-defined stroke, respectively, were 70.9% and 8.5% in Rhode Island and 74.1% and 7.7% in Massachusetts (chi(2), all P<0.001). The proportions of strokes classified as intracerebral hemorrhage or transient cerebral ischemia remained constant. The implementation of DRGs may have influenced coding of strokes to the ICD-9. Findings highlight the limitations of hospital discharge data for evaluating stroke subtypes and demonstrate the need for community-based surveillance for monitoring specific trends in stroke.

Effect of diagnosis-related groups on diagnostic methodology in the hospital laboratory

Traditionally physicians have ordered clinical laboratory tests for a variety of reasons. The establishment of a federally mandated prospective payment system for Medicare patients based on diagnosis-related groups has, among other things, necessitated a review of these reasons as well as the level of use of clinical laboratory services for a given diagnosis. Diagnosis-related group payment to hospitals is independent from the number of laboratory studies performed as long as the diagnosis-related group diagnosis is substantiated at the time the patient is discharged from the hospital. The cost-effective utilization of present tests as well as the adoption of new diagnostic methodologies depends on the assessment of whether a test possesses the appropriate parameters to be of sufficient diagnostic value. These factors include sensitivity, specificity, prevalence, speed, and the costs associated with false-negative or false-positive results. The assessment of the diagnostic value of present or future laboratory methods will require careful analysis relative to their financial impact both within the laboratory and for the hospital as a whole. The laboratory's knowledge of the diagnosis-related group accounting for the highest percentage of their hospital's costs, the highest volume of their cases, and the highest use of their services can aid in assessment of the appropriateness and level of laboratory services. An analysis of the percentage of microbiology costs associated with these diagnosis-related group categories for a large, tertiary care hospital is discussed.