Affiliation:
1. University of Belgrade , Faculty of Medicine , Dr Subotica 8, 11000 Belgrade , Serbia
Abstract
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.
Subject
Public Health, Environmental and Occupational Health
Reference30 articles.
1. Stosic S, Karanovic N. Health care economics in Serbia: current problems and changes. Vojnosanit Pregl. 2014;71(11):1055–61. doi: 10.2298/vsp120205002s.
2. World Bank. Serbia - doing more with less: addressing the fiscal crisis by increasing public sector productivity. Accessed March 10th, 2019 at: https://openknowledge.worldbank.org/handle/10986/3061.
3. 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: 10.1258/0951484011912564.
4. Geissler A, Quentin W, Scheller-Kreinsen D, Busse R. Introduction to DRGs in Europe: common objectives across different hospital systems. In: Busse R, Geissler A, Quentin W, Wiley M, editors. Diagnosis related groups in Europe: moving towards transparency, efficiency and quality in hospitals. Maidenhead: Open University Press, 2011:9-21.
5. Busse R, Geissler A, Aaviksoo A, Cots F, Häkkinen U, Kobel C, et al. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? BMJ. 2013;346:f3197. doi: 10.1136/bmj.f3197.
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献