[Variability in nursing workload within Swiss Diagnosis Related Groups].

Area of Science:

• Healthcare economics
• Nursing informatics
• Health services research

Context:

• Nursing care is a major cost driver within the Swiss Diagnosis Related Group (DRG) system.
• The DRG structure assumes nursing workloads balance within case groups, a premise questioned by existing research.
• Extrapolation of international findings to the SwissDRG system is unreliable.

Purpose:

• To analyze nursing workload data against DRG indicators to determine the necessity of nursing-specific SwissDRG classification criteria.
• To evaluate the explanatory power of the current DRG classification for nursing workload variability.
• To assess the homogeneity of nursing workload within DRG groups.

Summary:

• Analysis of 73,930 cases across 213 groups in ten hospitals revealed limited DRG explanatory power for nursing workload (R2=0.16 overall, R2=0.32 for inliers).
• Nursing workload homogeneity was unsatisfactory in 123 groups (CH < 0.67), and significantly defective in 24 groups (CH < 0.60).
• These findings indicate a substantial risk of financial misallocation due to imbalanced nursing workloads within DRG groups.

Impact:

• The study strongly indicates a need for developing nursing-care-specific SwissDRG classification criteria.
• Implementing such criteria could improve homogeneity and variance reduction, leading to more accurate financial resource allocation.
• This research provides evidence for refining healthcare reimbursement models based on specific nursing care needs.