SEVERITY OF ILLNESS WITHIN DRGS - HOMOGENEITY STUDY
SEVERITY OF ILLNESS WITHIN DRGS - HOMOGENEITY STUDY
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DOI：
10.1097/00005650-198603000-00005
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发表时间：
1986-03-01
期刊：
影响因子：
3
通讯作者：
CHAMBERS, AF
中科院分区：
文献类型：
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作者：
HORN, SD;HORN, RA;CHAMBERS, AF
作者评估了疾病严重程度指数解释每个DRG内资源使用的可变性的能力。数据来自15家医院，所有医院的HCFA DRG病例组合指数都大于1。数据集包括大约106,000个出院数据，其中包括出院摘要数据、财务数据和疾病严重程度数据。为了汇集15家医院的数据，作者将所有费用转换为成本，并将其标准化到1983财年。还对医学教育和工资水平进行了调整。疾病严重程度指数解释了94%的DRG中超过10%的资源使用变异性，其中包含97%的患者，以及36%的DRG中超过50%的资源使用的变异性，其中包含24%的患者。对于整个数据集，DRGs解释了资源使用中28%的可变性，而严重性调整后的DRGs解释了资源使用中的61%的可变性。因此，疾病严重程度指数解释了个别DRG内以及整个数据集中资源使用的大量可变性。当剔除异常值时，这种解释能力仍然存在。这些结果超过了之前的研究，这些研究基于六种疾病情况和/或仅在个别医院内进行了分析。研究结果表明，DRGs内部疾病严重程度差异的现象以及相应的资源使用差异，在代表美国所有部门和所有教学类型的15家医院中是一致的。
The authors assess the ability of the Severity of Illness Index to explain variability of resource use within each DRG. The data came from 15 hospitals, all of which had a HCFA DRG case mix index greater than 1. The data set comprised approximately 106,000 discharges, for which discharge abstract data, financial data, and Severity of Illness data were available. To pool the data over the 15 hospitals, the authors converted all charges to costs and normalized them to fiscal year 1983. Adjustments were also made for medical education and wage levels. The Severity of Illness Index explained more than 10% of the variability in resource use in 94% of the DRGs, which contained 97% of the patients, and more than 50% of the variability in resource use in 36% of the DRGs, which contained 24% of the patients. For the whole data set, DRGs explained 28% of the variability in resource use, and severity-adjusted DRGs explained 61% of the variability in resource use. Thus the Severity of Illness Index explained a large amount of the variability in resource use within individual DRGs as well as in the whole data set. This explanatory power remained when outliers were removed. These results go beyond previous studies that were based on six disease conditions and/or were analyzed only within individual hospitals. The findings indicate that the phenomenon of severity of illness differences within DRGs, and the corresponding differences in resource use, is consistent across 15 hospitals that represent all sections of the United States and all teaching types.