Diagnosis-Related Group Refinement with Diagnosis- and Procedure-Specific Comorbidities and Complications

• Published in: Medical care 1995-08, Vol.33 (8), p.806-827
• Main Authors: Freeman, Jean L., Fetter, Robert B., Park, Hayoung, Schneider, Karen C., Lichtenstein, Jeffrey L., Hughes, John S., Bauman, William A., Duncan, Charles C., Freeman, Daniel H., Palmer, George R.
• Format: Article
• Language: English
• Subjects: Adult; Comorbidity; Diagnosis-Related Groups - classification; Diagnosis-Related Groups - economics; Diagnosis-Related Groups - trends; Female; Hospital Records; Hospitalization; Humans; Male; Medicare; Models, Statistical; Prospective Payment System; Severity of Illness Index; Sex Factors; United States
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/00005650-199508000-00006

Diagnosis-related groups have been revised through more refined uses of secondary diagnoses. Under the refined diagnosis-related groups, patients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a different level of utilization for a given principal diagnosis or surgical procedure. The refined system was evaluated with national data from the Medicare program. Estimates of hospital costs and utilization based on refined diagnosis-related groups were more precise than those based on unrefined diagnosis-related groups. This approach to diagnosis-related group refinement does not represent a radical departure from the current diagnosis-related group framework and does not require new data collection efforts. Moreover, a payment system based on the refined model is less affected by the ordering of the diagnoses than under the existing diagnosis-related group system. How the refined diagnosis-related group framework can accommodate future refinements at all levels of the classification scheme is also discussed.