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Variation in resource use within diagnosis-related groups: the severity issue
Health Care Financing Review
|December 12, 1983
Summary
Diagnosis-Related Groups (DRGs) may not fully account for patient illness severity. Refining DRGs requires understanding variation sources and improving data sets before considering new grouping methods.
Area of Science:
- Health Services Research
- Medical Economics
- Healthcare Administration
Background:
- Concerns exist regarding the adequacy of Diagnosis-Related Groups (DRGs) in reflecting patient illness severity.
- Within-group variations in healthcare costs and resource utilization need precise definition beyond just severity.
Purpose of the Study:
- To evaluate the limitations of current DRG systems and data sources.
- To identify optimal strategies for modifying DRGs to better account for patient complexity and improve accuracy.
Main Methods:
- Analysis of the Uniform Hospital Discharge Data Set (UHDDS) and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system.
- Evaluation of the original DRG construction rules and their impact on within-group variation.
Main Results:
- Not all variation within DRGs is solely due to illness severity.
- Modifications utilizing existing UHDDS data, potentially with additional diagnoses and procedures, show promise.
- The limitations of UHDDS and ICD-9-CM coding require careful consideration and potential correction.
Conclusions:
- Accurate DRG modification necessitates a thorough understanding of within-group variation sources.
- Leveraging existing data elements within the UHDDS is the preferred approach for enhancing DRGs.
- Introducing new data elements should be a last resort due to complexity and cost.