Inpatient Laboratory Testing Research Articles

Implementing a Computer-Assisted Appropriateness Review Using DRG 182/183

The focus on patient outcomes as performance measures and on processes of care as systems to improve is intensifying. Nevertheless, appropriateness reviews are likely to remain essential (for example, studies evaluating inpatient admission, laboratory testing, invasive procedures, and discharge planning) for several reasons. Forbes Regional Hospital (Monroeville, PA) undertook to redesign the process of appropriateness reviews using a computer-assisted methodology. The change was predicated on accessing electronically recorded clinical data collected as part of a state-mandated discharge reporting requirement. More than 90% of diagnosis-related group 182/183 (gastrointestinal/esophagitis) admissions were deemed appropriate on the basis of later manual reviews. This redesign was accomplished at no added expense while the amount of time required to complete the study was decreased. The ability to easily examine relationships identified during the evaluation was also expanded. The experience led to greater enthusiasm on the part of the medical staff to pursue more quality improvement projects. Creation of software programs that can be used repeatedly, modified to change existing thresholds, or expanded to include other conditions was another benefit. Clinicians gained valuable experience and familiarity with information systems. Lastly, all this was accomplished without purchasing new hardware, acquiring updated software, or relying on the presence of an electronic medical record.

Prospective Reimbursement and Diabetes Mellitus

In order to curb spiraling health care costs, the federal government implemented prospective reimbursement to hospitals for inpatient services for all Medicare admissions. Beginning in the 1983 fiscal year, hospitals were paid a single rate for each Medicare admission, regardless of the cost involved in the care of any particular patient. This rate was determined by the diagnosisrelated group (DRG) into which the admitting diagnosis is classified.'2 In theory, DRGs should reduce unnecessary inpatient laboratory testing, procedures and services; discourage physicians from keeping patients in the hospital beyond what is medically justifiable; and encourage the use of the less expensive ambulatory setting for delivering health care.