背景:韩国诊断相关组(KDRG)于2003年进行了修订,修改了澳大利亚精细诊断相关组(AR-DRG)的复杂性调整机制。2014年,发现现有AR-DRG系统的并发症和合并症水平(CCL)与成本的相关性很小。
目的:根据澳大利亚的经验,审查了KDRG3.4版的CCL。
方法:本研究使用2011年的住院索赔数据。大约5,731,551集,其中有一个或没有并发症和合并症(CC),并符合纳入标准,被选中。在每个相邻诊断相关组(ADRG)中,使用方差分析,然后进行邓肯检验,分析CCL的平均住院费用差异。R2以三种模式呈现了差异模式:CCL很好地反映了复杂性(VALID);CCL2、3、4的平均电荷大于CCL0(部分有效);CCL不反映复杂性(NOTVALID)。
结果:共114(19.03%),190个(31.72%)和295个(49.25%)ADRG包含在VALID中,部分有效和无效,分别。CCL住院费用的平均R2为4.94%。有效的平均R2,部分有效和无效为4.54%,5.21%,4.93%,分别。
结论:CCL,使用二次诊断进行复杂性调整的第一步,表现低性能。如果高度精确的编码数据和成本数据可用,应重新评估次要诊断作为反映病例复杂性的变量的表现.
结论:自2003年以来,缺乏对KDRG复杂性调整机制的审查,导致过时的CC列表和级别不再反映当前的韩国医疗保健系统。可靠的成本数据(与收费)和准确的编码对于报销的准确性至关重要。
BACKGROUND: The Korean Diagnosis-Related Groups (KDRG) was revised in 2003, modifying the complexity adjustment mechanism of the Australian Refined Diagnosis-Related Groups (AR-DRGs). In 2014, the Complication and Comorbidity Level (CCL) of the existing AR-DRG system was found to have very little correlation with cost.
OBJECTIVE: Based on the Australian experience, the CCL for KDRG version 3.4 was reviewed.
METHODS: Inpatient claim data for 2011 were used in this study. About 5,731,551 episodes, which had one or no complication and comorbidity (CC) and met the inclusion criteria, were selected. The differences of average hospital charges by the CCL were analysed in each Adjacent Diagnosis-Related Group (ADRG) using analysis of variance followed by Duncan\'s test. The patterns of differences were presented with R 2 in three patterns: The CCL reflected the complexity well (VALID); the average charge of CCL 2, 3, 4 was greater than CCL 0 (PARTIALLY VALID); the CCL did not reflect the complexity (NOT VALID).
RESULTS: A total of 114 (19.03%), 190 (31.72%) and 295 (49.25%) ADRGs were included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average R 2 for hospital charge of CCL was 4.94%. The average R 2 in VALID, PARTIALLY VALID and NOT VALID was 4.54%, 5.21%, and 4.93%, respectively.
CONCLUSIONS: The CCL, the first step of complexity adjustment using secondary diagnoses, exhibited low performance. If highly accurate coding data and cost data become available, the performance of secondary diagnosis as a variable to reflect the case complexity should be re-evaluated.
CONCLUSIONS: Lack of reviewing the complexity adjustment mechanism of the KDRG since 2003 has resulted in outdated CC lists and levels that no longer reflect the current Korean healthcare system. Reliable cost data (vs. charge) and accurate coding are essential for accuracy of reimbursement.