Browse > Article
http://dx.doi.org/10.4332/KJHPA.2016.26.4.289

The Development of Korean Rehabilitation Patient Group Version 1.0  

Hwang, Soojin (Health Insurance Review and Assessment Service)
Kim, Aeryun (Health Insurance Review and Assessment Service)
Moon, Sunhye (Health Insurance Review and Assessment Service)
Kim, Jihee (Health Insurance Review and Assessment Service)
Kim, Jinhwi (Health Insurance Review and Assessment Service)
Ha, Younghea (Health Insurance Review and Assessment Service)
Yang, Okyoung (Health Insurance Review and Assessment Service)
Publication Information
Health Policy and Management / v.26, no.4, 2016 , pp. 289-304 More about this Journal
Abstract
Background: Rehabilitations in subacute phase are different from acute treatments regarding the characteristics and required resource consumption of the treatments. Lack of accuracy and validity of the Korean Diagnosis Related Group and Korean Out-Patient Group for the acute patients as the case-mix and payment tool for rehabilitation inpatients have been problematic issues. The objective of the study was to develop the Korean Rehabilitation Patient Group (KRPG) reflecting the characteristics of rehabilitation inpatients. Methods: As a retrospective medical record survey regarding rehabilitation inpatients, 4,207 episodes were collected through 42 hospitals. Considering the opinions of clinical experts and the decision-tree analysis, the variables for the KRPG system demonstrating the characteristics of rehabilitation inpatients were derived, and the splitting standards of the relevant variables were also set. Using the derived variables, we have drawn the rehabilitation inpatient classification model reflecting the clinical situation of Korea. The performance evaluation was conducted on the KRPG system. Results: The KRPG was targeted at the inpatients with brain or spinal cord injury. The etiologic disease, functional status (cognitive function, activity of daily living, muscle strength, spasticity, level and grade of spinal cord injury), and the patient's age were the variables in the rehabilitation patients. The algorithm of KRPG system after applying the derived variables and total 204 rehabilitation patient groups were developed. The KRPG explained 11.8% of variance in charge for rehabilitation inpatients. It also explained 13.8% of variance in length of stay for them. Conclusion: The KRPG version 1.0 reflecting the clinical characteristics of rehabilitation inpatients was classified as 204 groups.
Keywords
Rehabilitation; Korean Rehabilitation Patient Group; Case-mix;
Citations & Related Records
Times Cited By KSCI : 3  (Citation Analysis)
연도 인용수 순위
1 Kang GW, Park H, Shin YS. Refinement and evaluation of Korean Diagnosis Related Groups. Korean J Health Policy Adm 2004;14(1):121-147. DOI: https://doi.org/10.4332/kjhpa.2004.14.1.121.   DOI
2 Health Insurance Review and Assessment Service. KOPG definitions manual: version 1.2. Wonju: Health Insurance Review and Assessment service; 2014.
3 Park H, Kang GW, Koh Y. Development and evaluation of Korean ambulatory patient groups. Korean J Health Policy Adm 2006;16(1):17-40. DOI: https://doi.org/10.4332/kjhpa.2006.16.1.017.   DOI
4 Australasian Rehabilitation Outcomes Centre. SYNAPTIX data collection form [Internet]. Wollongong (NSW): University of Wollongong [cited 2013 Nov 8]. Available from: https://ahsri.uow.edu.au/aroc/index.html.
5 Centers for Medicare & Medicaid Services. Inpatient rehabilitation facility-patient assessment instrument (IRF-PAI) form [Internet]. Baltimore (MD): Centers for Medicare & Medicaid Services; [cited 2014 Jan 25]. Available from: https://www.cms.gov/Medicare/CMS-Forms/CMS-Form/ downloads/cms10036.pdf.
6 Health Insurance Review and Assessment Service. The development of KRPG: focusing on logic of classification. Wonju: Health Insurance Review and Assessment service; 2014.
7 Kang HC, Kim ES, Lee SK, Lee SJ, Chea YS, Choi BJ, et al. Functionality and usage of SAS Enterprise Miner for big data analysis. Seoul: Jau Academy; 2014.
8 Health Insurance Review and Assessment Service. The function and role of Health Insurance Review and Assessment Service. Wonju: Health Insurance Review and Assessment Service; 2015.
9 Turner-Stokes L, Sutch S, Dredge R, Eagar K. International casemix and funding models: lessons for rehabilitation. Clin Rehabil 2012;26(3):195-208. DOI: https://doi.org/10.1177/0269215511417468.   DOI
10 Sutherland JM, Walker J. Challenges of rehabilitation case mix measurement in Ontario hospitals. Health Policy 2008;85(3):336-348. DOI: https: //doi.org/10.1016/j.healthpol.2007.09.006.   DOI
11 Ko MJ, Shin JY, Lee LH, Song HJ. Review of patient classification system for rehabilitation in USA, Canada, Nordic countries. Wonju: Health Insurance Review and Assessment Service; 2013.
12 Centers for Medicare & Medicaid Services, Health and Human Services. Medicare program: inpatient rehabilitation facility prospective payment system for federal fiscal year 2015 [Internet]. Fed Regist 2014;79(151): 45872-45936 [cited 2014 Oct 20]. Available from: https://www.gpo.gov/fdsys/pkg/FR-2014-08-06/pdf/2014-18447.pdf.
13 Centers for Medicare & Medicaid Services. The inpatient rehabilitation facility-patient assessment instrument (IRF-PAI) training manual: effective 10/01/2014 [Internet]. Baltimore (MD): Centers for Medicare & Medicaid Services; 2014 [cited 2014 Oct 20]. Available from: https://www.cms. gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Downloads/IRF-PAI-Manual-201410.zip.
14 Green J, Gordon R, Blanchard M, Kobel C, Eagar K. Development of AN-SNAP version 4: final report. Wollongong (NSW): Centre for Health Service Development, University of Wollongong; 2015.
15 Turner-Stokes L, Sutch S, Dredge R. Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology. Clin Rehabil 2012;26(3):264-279. DOI: https://doi.org/10.1177/0269215511417467.   DOI
16 National Casemix Office, Health & Social Care Information Centre. The science of casemix [Internet]. Leeds: National Health Services; 2015 [cited 2016 Oct 31]. Available from: http://content.digital.nhs.uk/media/16916/ Science-of-Casemix-11/pdf/The_science_of_casemix_v1_1_April_2015.pdf.
17 Averill RF, Muldoon JH, Vertrees JC, Goldfield NI, Mullin RL, Fineran EC, et al. The evolution of casemix measurement using diagnosis related groups (DRGs): 3M Health Information Systems research report. Wallingford (CT): 3M Health Information Systems; 1998.
18 Eagar K, Gordon R, Hodkinson A, Green J, Eagar L, Erven J, et al. The Australian National Sub-Acute and Non-Acute Patient Classification (AN-SNAP): report of the National Sub-Acute and Non-Acute Casemix Classification Study. Wollongong (NSW): Centre for Health Service Development, University of Wollongong; 1997.
19 Aidinoff E, Front L, Itzkovich M, Bluvshtein V, Gelernter I, Hart J, et al. Expected spinal cord independence measure, third version, scores for various neurological levels after complete spinal cord lesions. Spinal Cord 2011;49(8):893-896. DOI: https://doi.org/10.1038/sc.2011.32.   DOI
20 Park H, Kang GW, Yoon S, Park EJ, Choi S, Yu S, et al. Refinement and evaluation of Korean outpatient groups for visits with multiple procedures and chemotherapy, and medical visit indicators. Health Policy Manag 2015;25(3):185-196. DOI: https://doi.org/10.4332/kjhpa.2015.25.3.185.   DOI
21 Health Insurance Review and Assessment Service. KRPG definitions manual: version 1.0. Wonju: Health Insurance Review and Assessment Service; 2016.
22 Health Insurance Review and Assessment Service. The 2nd-year results of the development of KRPG. Wonju: Health Insurance Review and Assessment Service; 2015.
23 Health Insurance Review and Assessment Service. International training report for patient classification system 2013. Wonju: Health Insurance Review and Assessment Service; 2013.
24 Han TR, Bang MS, Jeong SK. Rehabilitation medicine. 5th ed. Seoul: Kunja Press; 2014.
25 Australian Institute of Health and Welfare. Development of nationally consistent subacute and non-acute admitted patient care data definitions and guidelines. Canberra (ACT): Australian Institute of Health and Welfare; 2013.
26 Yoon MK, Lee EK, Yang OY. The development of delivery ADRG reflecting changes of childbirth environment in Korea. Proceedings of the 32nd annual PCSI conference; 2016 Oct 4-7; Dublin(Ireland): 2016 PCSI abstract book; 2016.
27 Health Insurance Review and Assessment Service. KDRG definitions manual: version 4.0. Wonju: Health Insurance Review and Assessment Service; 2016.
28 Green J, Gordon R. The development of version 2 of the AN-SNAP casemix classification system. Aust Health Rev 2007;31 Suppl 1:S68-S78. DOI: https://doi.org/10.1071/ah070s68.   DOI
29 Oh JY, Lee HJ, Shin HN, Yoo SY. A study on introduction of subacute hospital model. Wonju: Health Insurance Review and Assessment service; 2015.
30 Health Insurance Review and Assessment Service. The medical fee schedules under National Health Insurance 2015. Wonju: Health Insurance Review and Assessment Service; 2015.