scholarly journals Using endoscopic procedures forAN-DRG assignment:Australia leads the way

1998 ◽  
Vol 21 (4) ◽  
pp. 80 ◽  
Author(s):  
Kathryn M Antioch ◽  
Xichuan Zhang
Keyword(s):  
Operating Room ◽  
Digestive System ◽  
Diagnosis Related Groups ◽  
Diagnostic Category ◽  
Common Bile Duct Exploration ◽  
Therapeutic Procedure ◽  
Endoscopic Retrograde ◽  
Endoscopic Procedures ◽  
Major Diagnostic Category ◽  
Definition Of

The study reported in this article sought to develop Australian National Diagnosis Related Groups (AN-DRGs) using endoscopic procedures in Major Diagnostic Category (MDC) 6 (Digestive System) and MDC 7 (Hepatobiliary System and Pancreas) through statistical analysis of the Australian Casemix Clinical Committee's recommendations. Five ANOVA were undertaken on final recommendations for gastroscopy and colonoscopy in MDC 6. The Reduction in Variance (RIV) for the AN-DRGs in version 3 relative to version 2 increased by up to 14.6%, representing RIV of between 25.28% to 32.30%. For all ANOVAs, F>100, alpha < .0001, Coefficient of Variation (CV) was generally lower in version 3 by between 0.4% to 22.9%, except for AN-DRGs for other gastroscopy for major gastro-intestinal disease, which increased by 8.7%. Two ANOVA for Endoscopic Retrograde Cholangio-pancreatography Procedures (ERCP) recommendations resulted in RIV of up to 18.67%, F>100, alpha <- .0001 and CV up to 0.8091. MDC 6, in AN-DRG versions 3 and 3.1, has 11 AN-DRGs following the surgical hierarchy involving gastroscopy and colonoscopy. Patients assigned will not have an operating room procedure; they will have anon-operating room procedure that is either a complex therapeutic or other(diagnostic or therapeutic) procedure. Similar AN-DRGs are in MDC 7 for ERCP. Version 3.1 has expanded the definition of Common Bile Duct Exploration (CDE) to include ERCP. There is no separate AN-DRG for laparoscopy cholecystectomy.

Revising Diagnosis-Related Groups for Neonates

PEDIATRICS ◽  
1989 ◽  
Vol 84 (1) ◽  
pp. 49-61
Author(s):  
Leo K. Lichtig ◽  
Robert A Knauf ◽  
Albert Bartoletti ◽  
Lynn-Marie Wozniak ◽  
Robert H. Gregg ◽  
...  
Keyword(s):  
Variance Reduction ◽  
Diagnosis Related Groups ◽  
Operating Cost ◽  
Diagnostic Category ◽  
Pediatric Care ◽  
Duration Of Stay ◽  
Cost Variance ◽  
Major Diagnostic Category ◽  
Discharged Patients ◽  
Hospital Deaths

Groups of neonates who are usually treated at hospitals that provide specialized pediatric care are not adequately classified by the use of diagnosis-related groups (DRGs). Therefore, a set of revised DRGs, pediatric modified DRGs (PM-DRGs), have been developed. Use of PM-DRGs substantially improves the classification of neonates in the following ways: a single pediatric modified major diagnostic category has been defined to include only and all neonates (patients younger than 29 days of age when admitted to the hospital); deaths and transfers of newborns are no longer combined into a single group; birth weight (rather than diagnosis) is used as the primary variable to differentiate categories of neonates; and duration of mechanical ventilation, presence of major problems, and surgery are used to define specific PM-DRGs. A total of 46 PM-DRGs have been developed to replace the 7 DRGs for neonates. Based on a sample of discharged patients from 13 children's hospitals, the overall variance reduction in duration of stay for neonates using PM-DRGs was 38.7% compared with 20.4% for DRGs. Variance reduction for PM-DRGs was 45.9% compared with 16.3% for DRGs when operating cost per case was used instead of duration of stay. After removing outliers at 150 days, the duration of stay variance reduction was 53.3% vs 23.6%, respectively, and the operating cost variance reduction was 58.8% vs 17.8%, respectively.

A Comparison of the Resource Intensity of Inpatients in Urban and Rural Nonteaching Hospitals

1988 ◽  
Vol 18 (2) ◽  
pp. 323-333 ◽  
Author(s):  
Michael J. Long ◽  
James C. Fisher ◽  
Janice L. Dreachslin
Keyword(s):  
Diagnosis Related Groups ◽  
Pediatric Population ◽  
Diagnostic Category ◽  
Prospective Payment System ◽  
Rural Hospitals ◽  
Pediatric Residency ◽  
Urban Hospitals ◽  
Major Diagnostic Category ◽  
Exogenous Factors ◽  
Resource Intensity

PL 98–21 mandated a prospective payment system based on diagnosis related groups (DRGs) for all Medicare inpatients. The predetermined payment for each DRG is intended to reflect the resources used to treat patients within the DRG. Eventually, the system will allow for one payment level for each DRG in rural hospitals and a higher payment level for the same DRG in urban hospitals. This represents an equitable approach, provided there is not a predominance of high severity cases in rural hospitals and that higher costs in urban hospitals are reflective of higher priced exogenous factors beyond the control of the hospital. Equitability also requires that DRGs capture the resource intensity of treatment for a given classification of patients, equally for urban and rural patients. This work compares the pediatric population of urban hospitals without a pediatric residency program with that of rural hospitals in terms of major diagnostic category, DRG, disease severity, length of stay, and charges. It also compares the capacity of DRGs to explain the variation in resource consumption in urban and rural hospitals. A sample of 116,721 discharges from 130 urban hospitals and a sample of 54,073 discharges from 97 rural hospitals are used in this work. The results indicate that there is no difference in the patient populations of these two hospital groups. The results also indicate that DRGs explain only 50 percent of the variance in the resource variables, but this obtains equally for both populations.

scholarly journals Describing Serbian Hospital Activity Using Australian Refined Diagnosis Related Groups: A Case Study in Vojvodina Province

2019 ◽  
Vol 59 (1) ◽  
pp. 18-26
Author(s):  
Aleksandar P Medarevic
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Diagnostic Category ◽  
Percentile Method ◽  
Average Length Of Stay ◽  
Medical Groups ◽  
Group Homogeneity ◽  
Major Diagnostic Category

Abstract Introduction AR-DRG system for classification hospital episodes was implemented in Serbia to improve efficiency and transparency in the health system. Methods L3H3, IQR, and 10th–95th percentile methods were used to identify outlier episodes in the classification. Classification efficiency and within-group homogeneity were measured by an adjusted reduction in variance (R2) and a coefficient of variation (CV). Results There were 246,131 hospital episodes with a total 1,651,913 bed days from 14 hospitals. All episodes were classified into 652 groups of which 441 had CV lower than 100%. “Medical groups” accounted for 51% of groups and for 72% of episodes. Chemotherapy and vaginal delivery were the highest volume groups, with 5% and 4% of total episodes. Major diagnostic category 6 (MDC 6, Diseases of the digestive system) was the highest volume MDC, accounting for 11% of episodes. “Day-cases” and “prolonged hospitalisation” accounted for 21% and 3% of episodes, respectively. The average length of stay varied from 5.6 to 8.2 days. Adjusted R2 was 0.3 for untrimmed data. Trimming by L3H3, IQR, and 10th–95th percentile method improved the value of adjusted R2 to 0.61, 0.49, and 0.51, identifying 24%, 7%, and 7% of total cases as outliers, respectively. Mental diseases (MDC 19) remained the lowest adjusted R2 in untrimmed and trimmed datasets. Conclusion A long length of stay and a small percentage of “day-cases” characterized hospital activity in Vojvodina. Trimming methods significantly improved DRG efficiency. Future studies should consider cost data.

scholarly journals Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial

Endoscopy ◽  
2021 ◽  
Author(s):  
Leena Kylänpää ◽  
Vilja Koskensalo ◽  
Arto Saarela ◽  
Per Ejstrud ◽  
Marianne Udd ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Controlled Trial ◽  
Good Alternative ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Randomized Controlled ◽  
Biliary Sphincterotomy ◽  
Difficult Biliary Cannulation ◽  
Definition Of ◽  
Randomized Method

Abstract Background Difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) increases the risk of post-ERCP pancreatitis (PEP). The purpose of this prospective, randomized, multicenter study was to compare two advanced rescue methods, transpancreatic biliary sphincterotomy (TPBS) and a double-guidewire (DGW) technique, in difficult common bile duct (CBD) cannulation. Methods Patients with native papilla and planned CBD cannulation were recruited at eight Scandinavian hospitals. An experienced endoscopist attempted CBD cannulation with wire-guided cannulation. If the procedure fulfilled the definition of difficult cannulation and a guidewire entered the pancreatic duct, randomization to either TPBS or to DGW was performed. If the randomized method failed, any method available was performed. The primary end point was the frequency of PEP and the secondary end points included successful cannulation with the randomized method. Results In total, 1190 patients were recruited and 203 (17.1 %) were randomized according to the study protocol (TPBS 104 and DGW 99). PEP developed in 14/104 patients (13.5 %) in the TPBS group and 16/99 patients (16.2 %) in the DGW group (P = 0.69). No difference existed in PEP severity between the groups. The rate of successful deep biliary cannulation was significantly higher with TPBS (84.6 % [88/104]) than with DGW (69.7 % [69/99]; P = 0.01). Conclusions In difficult biliary cannulation, there was no difference in PEP rate between TPBS and DGW techniques. TPBS is a good alternative in cases of difficult cannulation when the guidewire is in the pancreatic duct.

Abstract 13658: Factors Associated With the Unnecessary Continuation of Cardiac Telemetry Through Discharge

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jordan L Gavin ◽  
Raja K MUTHARASAN
Keyword(s):  
Hospital Discharge ◽  
Diagnostic Category ◽  
Hospital Setting ◽  
Factors Associated ◽  
Discharge Disposition ◽  
Chicago Metropolitan Area ◽  
Major Diagnostic Category ◽  
Improvement Interventions ◽  
Related Group ◽  
Quality Improvement Interventions

Background: Inpatient cardiac telemetry remains over-utilized. Even when ordered judiciously, telemetry may be unnecessarily continued through discharge, adding cost, complexity, and inconvenience to care. Objective: To determine the rate of continuation of cardiac telemetry through time of hospital discharge, and the factors associated with its prolonged use. Methods: We analyzed 37,779 telemetry admissions between January 1 and December 31, 2019 at a 6-hospital healthcare system in the Chicago metropolitan area. We sought to evaluate whether hospital setting, location at time of telemetry order, ICU admission, major diagnostic category, cardiology consultation, or discharge disposition affected telemetry continuation through discharge. Results: In total, 47.1% of all telemetry admissions retained an active telemetry order through hospital discharge. The median and mean durations on telemetry were 71 hours and 101 hours, respectively. Patients admitted to a community hospital, hospitalized with a cardiac-related Medicare Severity-Diagnosis Related Group (MS-DRG), consulted on by cardiology, started on telemetry in the cardiac catheterization lab, or discharged home were more likely to be continued on telemetry through discharge. Odds ratios are shown in the figure, with an odds ratio > 1 indicating increased likelihood of being continued on telemetry through time of discharge. Conclusions: Once started on cardiac telemetry, nearly half of all patients remained on telemetry until discharge. Those with substantial cardiovascular-related care - as evidenced by procedure in the catheterization lab, cardiology consultation, or a cardiac MS-DRG - were more likely to be continued on telemetry through discharge. Quality improvement interventions aiming to reduce telemetry duration should focus on strengthening daily reviews of telemetry need, perhaps leveraging the electronic health record to link telemetry indications and duration.

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