scholarly journals Assessing the performance of a method for case-mix adjustment in the Korean Diagnosis-Related Groups (KDRG) system and its policy implications

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sujeong Kim ◽  
Byoongyong Choi ◽  
Kyunghee Lee ◽  
Sangmin Lee ◽  
Sukil Kim
Keyword(s):  
Classification System ◽  
Diagnosis Related Groups ◽  
Prospective Payment System ◽  
Pilot Project ◽  
Resource Consumption ◽  
Policy Implications ◽  
Clinical Complexity ◽  
Case Mix Adjustment ◽  
Low Performance ◽  
Post Hoc

Abstract Background To evaluate the performance of the patient clinical complexity level (PCCL) mechanism, which is the patient-level complexity adjustment factor within the Korean Diagnosis-Related Groups (KDRG) patient classification system, in explaining the variation in resource consumption within age adjacent diagnosis-related groups (AADRGs). Methods We used the inpatient claims data from a public hospital in Korea from 1 January 2017 to 30 June 2019, with 18 846 claims and 138 AADRGs. The differences in the total average payment between the four PCCL levels for each AADRG was tested using ANOVA and Duncan’s post hoc test. The three patterns of differences with R-squared were as follows: the PCCL reflected the complexity well (valid); the average payment for PCCL 2, 3, and 4 was greater than PCCL 0 (partially valid); the PCCL did not reflect the complexity (not valid). Results There were 9 (6.52%), 26 (18.84%), and 103 (74.64%) ADRGs included in the valid, partially valid, and not valid categories, respectively. The average R-squared values were 32.18, 40.81, and 35.41%, respectively, with an average R-squared for all patterns of 36.21%. Conclusions Adjustment using the PCCL in the KDRG classification system exhibited low performance in explaining the variation in resource consumption within AADRGs. As the KDRG classification system is used for reimbursement under the new DRG-based prospective payment system (PPS) pilot project, with plans for expansion, there should be an overall review of the validity of the complexity and rationality of using the KDRG classification system.

An Evaluation of the Patient Clinical Complexity Level (PCCL) Method for the Complexity Adjustment in the Korean Diagnosis-Related Groups (KDRG)

2020 ◽  
Author(s):  
Sujeong Kim ◽  
Byoongyong Choi ◽  
Kyunghee Lee ◽  
Sangmin Lee ◽  
Sukil Kim
Keyword(s):  
Classification System ◽  
Diagnosis Related Groups ◽  
Pilot Project ◽  
Resource Consumption ◽  
Complexity Level ◽  
Clinical Complexity ◽  
Low Performance ◽  
Post Hoc ◽  
Patient Classification System ◽  
Total Average

Abstract ObjectiveTo evaluate the performance of the Patient Clinical Complexity Level (PCCL) mechanism, which is the patient level complexity adjustment factor within the Korean Diagnosis-Related Groups (KDRG) patient classification system, for explaining the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs).MethodsWe used the inpatient claims data from a public hospital in Korea from January 1, 2017 to June 30, 2019, with 18,846 claims and 138 Age Adjacent Diagnosis-related groups (AADRGs). The differences in the total average payment between the four PCCL levels for each AADRG was tested using ANOVA and Duncan’s post-hoc test. The three patterns of the differences with R-squared were: the PCCL reflected the complexity well (Valid); the average payment of PCCL 2, 3, 4 was greater than PCCL 0 (Partially Valid); the PCCL did not reflect the complexity (Not Valid).ResultsThere were 9 (6.52%), 26 (18.84%), and 103 (74.64%) ADRGs included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average R-squared in VALID, PARTIALLY VALID, and NOT VALID was 32.18%, 40.81%, and 35.41% respectively, with the average R-squared for all patterns of 36.21%.ConclusionsAdjusting using PCCL in the KDRG classification system exhibited low performance to explain the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs). As the KDRG classification system is used for reimbursement under the New DRG-based PPS pilot project with plans for expansion, there should be an overall review of the validity of the complexity and rationality of using the KDRG classification system.

The Role of Diagnosis-related Groups in Health Care Organizations Financing

2010 ◽  
pp. 132-143
Author(s):  
T. Sklyar
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Single Channel ◽  
Diagnosis Related Groups ◽  
Health Care Organization ◽  
Prospective Payment System ◽  
Pilot Project ◽  
Care Organization ◽  
Theoretical Approaches

The article describes theoretical approaches to the choice of a hospital financing method. The paper discusses three ways of incorporating diagnosis-related groups in health care, i. e. in a prospective payment system which is widely spread abroad; within a pilot project on the single-channel financing of health care organizations in Russia; introducing diagnosis-related groups in St. Petersburg as a basis of health care organization costs recovery.

scholarly journals Accuracy of the All Patient Refined Diagnosis Related Groups Classification System in Congenital Heart Surgery

2014 ◽  
Vol 97 (2) ◽  
pp. 641-650 ◽  
Author(s):  
Aimee S. Parnell ◽  
Justine Shults ◽  
J. William Gaynor ◽  
Mary B. Leonard ◽  
Dingwei Dai ◽  
...  
Keyword(s):  
Classification System ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Diagnosis Related Groups ◽  
Congenital Heart Surgery

The state of the knowledge-based economy in the Arab world: cases of Qatar and Lebanon

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Tarek Ben Hassen
Keyword(s):  
Arab World ◽  
Innovation System ◽  
Policy Implications ◽  
Structured Interviews ◽  
Content Type ◽  
Knowledge Based ◽  
Current State ◽  
Knowledge Based Economy ◽  
Low Performance ◽  
Ict Infrastructure

PurposeThe purpose of this paper is to examine the current state of the knowledge-based economy in two distinctive case studies in the Arab World: Qatar and Lebanon. Based on five aspects of the knowledge-based economy namely: ICT, human capital and education; innovation, entrepreneurship, and economic and institutional regime, we provide a careful view of the obstacles and challenges that Qatar and Lebanon are facing and how this is hindering their transformation to a knowledge-based economy.Design/methodology/approachThe methodology of this research is based on a literature review and information collected through semi-structured interviews with the different stakeholders of the knowledge-based economy in Qatar and Lebanon.FindingsThe research reveals that numerous factors shape the knowledge-based economy in Qatar and Lebanon. In Qatar, the main strength of the knowledge-based economy is the determination of the Qatari government to diversify the economy and the main weaknesses are the shortage of qualified human resources, the fear of failure and the low performance of the innovation system. In Lebanon, the knowledge-based economy is driven by the education system and the entrepreneurship culture, nevertheless the political instability of the country and the weak ICT infrastructure impede its development.Originality/valueThese findings contribute to the clarification and critical analysis of the current state of the knowledge-based economy in Qatar and Lebanon, which would have several policy implications.

The DRG Prospective Payment System, Age, Resource Consumption, and Outcome for Peripheral Vascular Surgical Patients

1989 ◽  
Vol 23 (1) ◽  
pp. 43-50
Author(s):  
Eric Munoz ◽  
Edgar Borrero ◽  
Jonathan Goldstein ◽  
Katherine Mulloy ◽  
John Chang ◽  
...  
Keyword(s):  
Prospective Payment System ◽  
Payment System ◽  
Resource Consumption ◽  
Surgical Patients ◽  
Prospective Payment ◽  
Peripheral Vascular

scholarly journals Active MMP-8 (aMMP-8) as a Grading and Staging Biomarker in the Periodontitis Classification

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 61 ◽  
Author(s):  
Timo Sorsa ◽  
Saeed Alassiri ◽  
Andreas Grigoriadis ◽  
Ismo T. Räisänen ◽  
Pirjo Pärnänen ◽  
...  
Keyword(s):  
Classification System ◽  
Point Of Care ◽  
Bleeding On Probing ◽  
Active Matrix ◽  
Spearman's Rho ◽  
Periodontal Breakdown ◽  
Severe Periodontitis ◽  
Spearman’S Rho ◽  
Bonferroni Test ◽  
Post Hoc

The aim of this study was to investigate the utility of incorporating active matrix metalloproteinase-8 (aMMP-8) as a biomarker into the new periodontitis classification system (stage/grade) presented in 2018. This study included 150 Greek adults aged 25–78, of whom 74 were men and 76 women. Participants were tested with an aMMP-8 point-of-care mouthrinse test, after which a full-mouth clinical examination was performed to assess their periodontal and oral health. The aMMP-8 levels in mouthrinse were significantly lower among healthy patients compared with patients in more severe periodontitis stages and grades (Kruskal–Wallis test and Dunn–Bonferroni test for pairwise post-hoc comparisons; p < 0.01 and p < 0.05, respectively). Furthermore, aMMP-8 levels were less correlated with plaque levels than bleeding on probing (BOP) (Spearman’s rho = 0.269, p < 0.001; Spearman’s rho = 0.586, p < 0.001); respectively). Thus, aMMP-8 was more robust to the confounding effects of oral hygiene than traditional periodontal parameter bleeding on probing. The aMMP-8 point-of-care mouthrinse test can be utilized as an adjunctive and preventive diagnostic tool to identify periodontal disease, classified by stage and grade, and ongoing periodontal breakdown chairside in clinical practice in only 5 min. Overall, integrating aMMP-8 into the new periodontitis classification system seems beneficial.

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 The Application of the Ten Group Classification System (TGCS) in Caesarean Delivery Case Mix Adjustment. A Multicenter Prospective Study

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e62364 ◽  
Author(s):  
Gianpaolo Maso ◽  
Salvatore Alberico ◽  
Lorenzo Monasta ◽  
Luca Ronfani ◽  
Marcella Montico ◽  
...  
Keyword(s):  
Prospective Study ◽  
Classification System ◽  
Caesarean Delivery ◽  
Group Classification ◽  
Case Mix ◽  
Case Mix Adjustment ◽  
Multicenter Prospective Study

scholarly journals Validation of a Speed-Based Classification System Using Quantitative Measures of Walking Performance Poststroke

2008 ◽  
Vol 22 (6) ◽  
pp. 672-675 ◽  
Author(s):  
Mark G. Bowden ◽  
Chitralakshmi K. Balasubramanian ◽  
Andrea L. Behrman ◽  
Steven A. Kautz
Keyword(s):  
Classification System ◽  
Walking Speed ◽  
Step Length ◽  
Self Report ◽  
Group Differences ◽  
Community Based ◽  
Walking Behavior ◽  
Significant Difference ◽  
Walking Performance ◽  
Post Hoc

Background. For clinical trials in stroke rehabilitation, self-selected walking speed has been used to stratify persons to predict functional walking status and to define clinical meaningfulness of changes. However, this stratification was validated primarily using self-report questionnaires. Objective. This study aims to validate the speed-based classification system with quantitative measures of walking performance. Methods. A total of 59 individuals who had hemiparesis for more than 6 months after stroke participated in this study. Spatiotemporal and kinetic measures included the percentage of total propulsion generated by the paretic leg (Pp), the percentage of the stride length accounted for by the paretic leg step length (PSR), and the percentage of the gait cycle spent in paretic preswing (PPS). Additional measures included the synergy portion of the Fugl-Meyer Assessment and the average number of steps/day in the home and community measured with a step activity monitor. Participants were stratified by self-selected gait speed into 3 groups: household (<0.4 m/s), limited community (0.4-0.8 m/s), and community (>0.8 m/s) ambulators. Group differences were analyzed using a Kruskal—Wallis H test with rank sums test post hoc analyses. Results. Analyses demonstrated a main effect in all measures, but only steps/day and PPS demonstrated a significant difference between all 3 groups. Conclusions. Classifying individuals poststroke by self-selected walking speed is associated with home and community-based walking behavior as quantified by daily step counts. In addition, PPS distinguishes all 3 groups. Pp differentiates the moderate from the fast groups and may represent a contribution to mechanisms of increasing walking speed. Speed classification presents a useful yet simple mechanism to stratify subjects poststroke and may be mechanically linked to changes in PPS.

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