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.

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.

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 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.

scholarly journals 1356. Ribavirin Use in Hospitalized Children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S689-S690
Author(s):  
William R Otto ◽  
Giyoung Lee ◽  
Cary Thurm ◽  
Jeffrey Gerber ◽  
Adam Hersh
Keyword(s):  
Diagnosis Related Groups ◽  
Pediatric Population ◽  
Health Information System ◽  
International Classification Of Diseases ◽  
Route Of Administration ◽  
Administrative Database ◽  
Hospitalized Children ◽  
Syncytial Virus ◽  
Tract Infections ◽  
Over Time

Abstract Background Respiratory syncytial virus (RSV) infection is a significant cause of morbidity and mortality in immunocompromised children. Aerosolized ribavirin is approved for treatment of RSV lower respiratory tract infections. However, due to high cost, challenges to administration and uncertainty about benefit, use is limited. Recent studies in adult patients have reported similar outcomes between patients treated with aerosolized and oral ribavirin. We sought to characterize trends in use of ribavirin for hospitalized children. Methods We used the Pediatric Health Information System (PHIS), an administrative database which contains resource utilization data from 52 children’s hospitals, to perform a retrospective analysis of children hospitalized between January 1, 2010 through December 31, 2019 who were billed for ribavirin treatment. Data related to ribavirin use (number of courses, route of administration) and clinical characteristics were abstracted. International Classification of Diseases, 9th Revision (ICD-9) or 10th Revision (ICD-10) codes and All Patients Refined Diagnosis Related Groups (APR DRG) classifications were used to define underlying clinical conditions and illness severity. Summary statistics were used to describe patient characteristics and the use of ribavirin. Results Thirty-eight hospitals reported ribavirin use; 1 hospital was excluded due to inaccuracies in charge coding. We identified 837 children who received 937 courses of ribavirin (Table 1). The overall frequency of ribavirin use was unchanged over the study period, and the number of ribavirin treatment courses per hospital ranged from 1 to 228 (Figure 1). The most frequent routes of administration were inhalation (603/937, 64%) and oral (322/937, 34%). There was a decrease in the use of aerosolized ribavirin over time, with a corresponding increase in the use of oral ribavirin (Figure 2). Table 1: Patient demographics (N=837) Figure 1: Total ribavirin treatment courses over the study period (a) by year and (b) by treating hospital Figure 2: (a) Route of administration (inhalation versus oral), by year during the study period and (b) use of oral ribavirin over time during the study period Conclusion Although overall prescribing rates of ribavirin in hospitalized children have remained stable, use varies widely across centers and the proportion of oral ribavirin use has increased over time. Comparative effectiveness studies are needed in the pediatric population to evaluate outcomes of children treated with aerosolized vs. oral ribavirin. Disclosures All Authors: No reported disclosures

scholarly journals Differences in Percutaneous Injury Patterns in A Multi-Hospital System

2003 ◽  
Vol 24 (10) ◽  
pp. 731-736 ◽  
Author(s):  
Hilary M. Babcock ◽  
Victoria Fraser
Keyword(s):  
Case Series ◽  
Rural Hospitals ◽  
Teaching Hospitals ◽  
Radiology Department ◽  
Chi Square ◽  
Hospital System ◽  
Injury Rates ◽  
Urban Hospitals ◽  
Rural And Urban ◽  
Different Types

AbstractObjective:Determine differences in patterns of percutaneous injuries (PIs) in different types of hospitals.Design:Case series of injuries occurring from 1997 to 2001.Setting:Large midwestern healthcare system with a consolidated occupational health database from 9 hospitals, including rural and urban, community and teaching (1 pediatric, 1 adult) facilities, ranging from 113 to 1,400 beds.Participants:Healthcare workers injured between 1997 and 2001.Results:Annual injury rates for all hospitals decreased during the study period from 21 to 16.5/100 beds (chi-square for trend = 22.7; P = .0001). Average annual injury rates were higher at larger hospitals (22.5 vs 9.5 Pis/100 beds; P = .0001). Among small hospitals, rural hospitals had higher rates than did urban hospitals (14.87 vs 8.02 PIs/100 beds; P = .0143). At small hospitals, an increased proportion of injuries occurred in the emergency department (13.7% vs 8.6%; P = .0004), operating room (32.3% vs 25.4%; P = .0002), and ICU (12.3% vs 9.4%; P = .0225), compared with large hospitals. Rural hospitals had higher injury rates in the radiology department (7.7% vs 2%; P = .0015) versus urban hospitals. Injuries at the teaching hospitals occurred more commonly on the wards (28.8% vs 24%; P = .0021) and in ICUs (11.4% vs 7.8%; P = .0006) than at community hospitals. Injuries involving butterfly needles were more common at pediatric versus adult hospitals (15.8% vs 6.5%; P = .0001). The prevalence of source patients infected with HIV and hepatitis C was higher at large hospitals.Conclusions:Significant differences exist in injury rates and patterns among different types of hospitals. These data can be used to target intervention strategies.

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.

Psychiatric morbidity among West Africans and West Indians living in London

1977 ◽  
Vol 7 (2) ◽  
pp. 317-329 ◽  
Author(s):  
G. G. C. Rwegellera
Keyword(s):  
Psychiatric Illness ◽  
Psychiatric Morbidity ◽  
Diagnostic Category ◽  
West Indians ◽  
Sampling Frame ◽  
Reactive Depression ◽  
West Africans ◽  
Major Diagnostic Category

synopsisAll West Africans and West Indians living in Camberwell who made a psychiatric contact between 1 January 1965 and 31 December 1968 were selected using the Camberwell Psychiatric Register as a sampling frame. Inception rates of psychiatric illness were then calculated using the 1966 10% census figures for West Africans and West Indians in Camberwell. The rates found were compared to those among the British living in Camberwell. For each major diagnostic category, with the exception of reactive depression and paranoid states, the inception rates are significantly higher among West Africans than West Indians. They are also significantly higher among West Indians than the British. However, the differences in inception rates are generally greater between West Africans and West Indians than between the latter and the British.

Aetiologies of diarrhoea in adults from urban and rural treatment facilities in Bangladesh

2014 ◽  
Vol 143 (7) ◽  
pp. 1377-1387 ◽  
Author(s):  
F. FERDOUS ◽  
S. AHMED ◽  
F. D. FARZANA ◽  
J. DAS ◽  
M. A. MALEK ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Diarrhoeal Disease ◽  
The Elderly ◽  
Rural Hospitals ◽  
Surveillance Systems ◽  
Younger Adults ◽  
Urban Hospitals ◽  
Urban Adults ◽  
Treatment Facilities ◽  
Demographic Background

SUMMARYThe objective of our analysis was to describe the aetiology, clinical features, and socio-demographic background of adults with diarrhoea attending different urban and rural diarrhoeal disease hospitals in Bangladesh. Between January 2010 and December 2011, a total of 5054 adult diarrhoeal patients aged ⩾20 years were enrolled into the Diarrhoeal Disease Surveillance Systems at four different hospitals (two rural and two urban) of Bangladesh. Middle-aged [adjusted odds ratio (aOR) 0·28, 95% confidence interval (CI) 0·23–0·35,P < 0·001] and elderly (aOR 0·15, 95% CI 0·11–0·20,P < 0·001) patients were more likely to present to rural diarrhoeal disease facilities than urban ones.Vibrio choleraewas the most commonly isolated pathogen (16%) of the four pathogens tested followed by rotavirus (5%), enterotoxigenicEscherichia coli(ETEC) (4%), andShigella(4%). Of these pathogens,V. cholerae(19%vs. 11%,P < 0·001), ETEC (9%vs. 4%,P < 0·001), and rotavirus (5%vs. 3%,P = 0·013) were more commonly detected from patients presenting to urban hospitals than rural hospitals, butShigellawas more frequently isolated from patients presenting to rural hospitals than urban hospitals (7%vs. 2%,P< 0·001). The isolation rate ofShigellawas higher in the elderly than in younger adults (8%vs. 3%,P < 0·001). Some or severe dehydration was higher in urban adults than rural adults (P< 0·001). Our findings indicate that despite economic and other progress made, conditions facilitating transmission ofV. choleraeandShigellaprevail in adults with diarrhoea in Bangladesh and further efforts are needed to control these infections.

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