Distinguishing between tertiary and secondary facilities: a case study of cardiac diagnostic-related groups (DRGs)

Area of Science:

• Health Services Research
• Hospital Management
• Cardiology

Background:

• Tertiary and secondary hospitals provide different levels of cardiac care.
• Understanding the product mix of Diagnosis Related Groups (DRGs) is crucial for resource allocation.
• Variability in patient complexity within DRGs can impact resource utilization.

Purpose of the Study:

• To develop a classification for tertiary cardiac DRGs.
• To investigate differences in tertiary versus secondary cardiac DRG product mix across New Zealand district health boards (DHBs).

Main Methods:

• Analysis of 67 cardiac DRGs from 85,442 cases.
• Utilized cost weights and patient comorbidity complexity levels as proxies for complexity.

Main Results:

• Significant severity variability observed within certain DRGs.
• Five DHBs predominantly provide 27 high-cost, tertiary-identified cardiac DRGs.
• These five DHBs exhibit higher average DRG severity compared to other DHBs.

Conclusions:

• New Zealand's tertiary hospitals manage a more complex cardiac DRG product mix than secondary hospitals.
• Current funding models based on case weights may not adequately account for the higher resource needs of tertiary cardiac care.