[A pilot study about implementation in Romanian medical activity of diagnosis related groups classification]

The inpatient and outpatient classification in homogeneous groups (Diagnosis Related Groups--DRGs and Ambulatory Patient Groups--APGs) it is usually used for the medical resources' management and in second place for the structure's and the sanitary system's function evaluation, for the establishment of necessities and priorities in medical care of a population, for the establishment of the used resources etc. These elements given by the method are essential for a sanitary reform. In this whey the possibility of implementation for the method in Romanian medical practice, we've proposed to evaluate it in a pilot study.

The study was made on an adult population sample from Cluj-Napoca. It was made out of 311 subjects. The data were taken in unitary mode using a record questionnaire. The database was performed in the ACCESS program. For the statistic there were used the information pack EpiInfo version 6, 04. 1996. The reference year was 1997. To observe the evolution of the phenomenon we compared with a control group from 1987 composed by matching 1:1.

In the sample females were significatively dominant (65.4%, p < 0.00001) and elders (the age group of 60-69 years represent 54%, p < 0.00001). In 1987 the elders > or = 60 years were the once how had in a significantly way more often medical care both in and outpatient. In 1997, the medical care for adults was close to the once for elders. In evolution, for a 10 year period, the ambulatory assistance decreased and the specialized assistants in the hospital increased (unique and multiple). The risk of hospitalization in 1997 compared to 1987, is significatively bigger: OR = 2.56 (IC 95%: 1.61-4.09), p < 0.001. The pathology assisted in ambulatory and in hospital was represented more often by the cardiovascular system affections (CMD 05-61.1%) in witch the arterial hypertension is dominant (DRG 191).

To produce DRGs and APGs, in the actual sanitary system, from the university center Cluj-Napoca it is possible, but the development of the actual informational system is necessary. The implementation of the classification method needs from the medical practice side it's standardization because the homogeneous patients consume the same quantity of resources from the medical point of view. The medical service separation in smaller and bigger hospitalization is necessary.