DRG (Diagnosis Related Groups) Refinement: A Feasibility Assessment Using Stage of Disease, Age, and Unrelated Comorbidity

摘要

The purpose of this study was to investigate the possible refinement of Diagnosis Related Groups (DRGs) currently being used to classify cases for the Medicare prospective payment system for hospitals. The study used measures of disease severity, unrelated comorbidity, and age. Analyses were based on Medicare hospital discharge and cost data from two states. A small set of DRGs was selected for analysis purposes, and adjacent DRGs currently split on age and/or complications or comorbidities were combined to form ten disease categories. Within these categories, multivariate analyses were conducted to examine the amount of variation in cost and length of stay explained by differences in principal condition, stage of disease, unrelated comorbidity, and age. The study also proposed alternative groupings based on these measures within four of the ten disease categories and compared their clinical and statistical homogeneity to the existing DRGs splits to determine the feasibility and utility of DRG refinement.