Browse > Article
http://dx.doi.org/10.4332/KJHPA.2013.23.1.044

Evaluation of the Homogeneity of Korean Diagnosis Related Groups  

Kim, Hyung Seon (Health Insurance Review and Assessment Service)
Lee, Sun Hee (Department of Preventive Medicine, Ewha Womans University School of Medicine)
Nam, Chung Mo (Department of Preventive Medicine, Yonsei University College of Medicine)
Publication Information
Health Policy and Management / v.23, no.1, 2013 , pp. 44-51 More about this Journal
Abstract
Background: This study designed to evaluate the homogeneity of Korean diagnosis related group (KDRG) version 3.4 classification system. Methods: The total 5,921,873 claims data submitted to the Health Insurance Review and Assessment Service during 2010 were used. Both coefficient of variation (CV) and reduction in variance of cost were measured for evaluation. This analysis was divided into before and after trimming outliers at the level of adjacent DRG (ADRG), aged ADRG (AADRG) split by age, and DRG split by complication and comorbidity. Results: At the each three level of ADRG, AADRG, and DRG, there were 38.9%, 38.7%, and 30.0% of which had a CV > 100% in the untrimmed data and there were 1.4%, 1.4%, and 1.9% in the trimmed one. Before trimming outliers, ADRGs explained 52.5% of the variability in resource use, AADRGs did 53.1% and DRGs did 57.1%. The additional explanatory power by age and comorbidity and complication (CC) split were 0.6%p and 4.6%p for each, which were statistically significant. After trimming outliers, ADRGs explained 75.2% of the variability in resource use, AADRGs did 75.6%, and DRGs did 77.1%. The additional explanatory power were 0.4%p and 2.0%p for each, which were statistically significant too. Conclusion: The results demonstrated that KDRG showed high homogeneity within groups and performance after trimming outliers. But there were DRGs CV > 100% after age or CC split and the most contributing factor to high performance of KDRG was the ADRG rather than age or CC split. Therefore, it is recommended that the efforts for improving clinical homogeneity of KDRG such as review of the hierarchical structure of classification systems and classification variables.
Keywords
Diagnosis related group; Homogeneity; Patient classification;
Citations & Related Records
Times Cited By KSCI : 3  (Citation Analysis)
연도 인용수 순위
1 Stausberg J, Kiefer E. Homogeneity of the German diagnosis-related groups. Health Serv Manage Res 2010;23(4):154-159.   DOI   ScienceOn
2 Wynn BO. Understanding Medicare severity-DRGs. Santa Monica (CA): RAND; 2007.
3 Wynn BO, Beckett MK, Hilborne LH, Scott M, Bahney B. Evaluation of severity-adjusted DRG systems. Santa Monica (CA): RAND; 2007.
4 Palmer GR, Reid B, Aisbett C, Fields S, Kearns D, Fetter R. Evaluating the performance of the Australian national diagnosis related groups. Sydney: Centre for Hospital Management and Information Systems Research, University of New South Wales; 1997.
5 Palmer G, Reid B. Evaluation of the performance of diagnosis-related groups and similar casemix systems: methodological issues. Health Serv Manage Res 2001;14(2):71-81.   DOI   ScienceOn
6 Park HY, Park KD, Shin YS. On feasibility of ambulatory KDRGs for the classification of health insurance claims. Korean J Health Policy Admin 2003; 13(1):98-115.   과학기술학회마을   DOI   ScienceOn
7 Reid B, Palmer G, Aisbett C. The performance of Australian DRGs. Aust Health Rev 2000;23(2):20-31.   DOI
8 Rosenberg MA, Browne MJ. The impact of the inpatient prospective payment system and diagnosis-related groups: a survey of the literature. N Am Actuar J 2001;5(4):84-94.   DOI
9 Shin YS, Lee YS, Park HY, Yeom YK. Development and evaluation of Korean diagnosis related groups: medical service utilization of inpatients. Korean J Prev Med 1993;26(2):293-309.   과학기술학회마을
10 Lorenzoni L, Pearson M. Description of alternative approaches to measure and place a value on hospital products in seven OECD countries. OECD Health Working Papers, No. 56. Paris: Organization for Economic Cooperation and Development Publishing; 2011.
11 Mayes R. The origins, development, and passage of Medicare's revolutionary prospective payment system. J Hist Med Allied Sci 2007;62(1):21-55.   DOI
12 Metral P, Ducret N, Patris A, Steunou P. Improving case mix for description and funding in rehabilitation in France: additive model is better than tree-classification. BMC Health Serv Res 2008;8(1):A2.   DOI
13 National Casemix and Classification Centre. AR-DRG definitions manuals [Internet]. Sydney: National Casemix and Classification Centre; 2011 [cited 2012 Jan 9]. Available from: http://nccc.uow.edu.au/ardrg/definitionsmanuals/index.html.
14 National Health Service Information Centre. HRG4 companion [Internet]. London: National Health Service Information Centre; 2011 [cited 2012 Feb 6]. Available from: http://www.ic.nhs.uk/webfiles/Services/casemix/HRG4%20Companion%20v1.1.pdf.
15 Hsia DC, Krushat WM, Fagan AB, Tebbutt JA, Kusserow RP. Accuracy of diagnostic coding for medicare patients under the prospective-payment system. N Engl J Med 1988;318(6):352-355.   DOI   ScienceOn
16 Fischer W, Blanco J, Butt M, Hund M, Boldt C. Leistungsorientiertes tarifmodell rehabilitation (LTR). Neurol Rehabil 2010;3(16):1-18.
17 Frank RG, Lave JR. The psychiatric DRGs. Are they different? Med Care 1985;23(10):1148-1155.   DOI   ScienceOn
18 Hsia DC, Ahern CA, Ritchie BP, Moscoe LM, Krushat WM. Medicare reimbursement accuracy under the prospective payment system, 1985 to 1988. JAMA 1992;268(7):896-899.   DOI   ScienceOn
19 Kang GW, Park H, Shin YS. Refinement and evaluation of Korean diagnosis related groups. Korean J Health Policy Admin 2004;14(1):121-147.   과학기술학회마을   DOI   ScienceOn
20 Kawabuchi K. DRG/PPS and hospital management. Lee JH, translator. Gwangju: Korea Medical Consulting; 2000.
21 Kim YJ. The adequacy on DRG classification system in obstetric group [master's thesis]. Seoul: Yonsei University; 2003.
22 Lee SH. Problems of introduction of DRG payment in kidney disease and improvement plan. Seoul: Ewha Womans University; 2010.
23 Averill RF, Muldoon JH, Vertrees JC, Goldfield NI, Mullin RL, Fineran EC, et al. The evolution of casemix measurement using diagnosis related groups (DRGs). Wallingford (CN): 3M Health Information Systems; 1999.
24 Busse R, Geissler A, Quentin W, Wiley M. Diagnosis-related groups in Europe. Maidenhead: Open University Press; 2011.
25 Casas M. Issues for comparability of DRG statistics in Europe: results from EURODRG. Health Policy 1991;17(2):121-132.   DOI   ScienceOn
26 Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD. Case mix definition by diagnosis-related groups. Med Care 1980;18(2 Suppl):iii, 1-53.
27 Casemix Design Authority. The casemix design framework 2009: performance measurement techniques. London: National Health Service Information Centre; 2009.
28 Choi MA. A study of KDRG classification system and factors related to length of stay using data mining methodology: for the case of cesarean section [master's thesis]. Seoul: Yonsei University; 2001.
29 Chae Y. Comparison of DRG classification systems in a number of countries [master's thesis]. Seoul: Ewha Womans University; 2001.
30 Averill RF, Goldfield NI, Hughes JS, Bonazelli J, Mccullough EC, Mullin R, et al. 3M APR DRG classification system version 29.0. definitions manual. Wallingford (CN): 3M Health Information Systems; 2011.