Using Thai DRGs Methodology For The Study Of Grouping Inpatients In Four Public Hospitals In Yunnan Province:Case Study Of Digestive Diseases

ObjectiveTo study the grouping of inpatients of digestive diseases in four public hospitals in Yunan Province by using Thai DRGs methodology and meanwhile finding out problems in the process of grouping. To learn the advantages of Thai DRGs methodology in order to provide suggestions for the implementation of DRGs in Yunnan Province, especially in cutting length of stay and reducing medical costs.MethodsFields associated with the grouping in16292hospitalized patients’inpatient records of digestive diseases in four public hospitals in Yunan Province during2009-2010were colleted, grouped by using Thai DRGs methodology, then analysed and evaluated the effect of grouping. The grouping variables included principal diagnosis, secondary diagnosis, surgical coding, sex, age, admission weight, length of stay, discharge type, admission date&time, discharge date&time. SPSS and Excel were used for data analysis and statistical methods included descriptive statistics, rank sum test.Results1.16292inpatients of digestive diseases were divided into43disease clusters,155DRGs groups. The average age of all was (42.47±24.81) years old; male9525accounting for58.46%, female6767accounting for41.55%; length of stay median was7.00days, quartile range was7.00days; total fee of hospitalization median was3672.99yuan, quartile range was3279.34yuan. 2. Total fee primarily consisted of five categories. Among it, expenses of medicine accounted for44.28%with a median of1203.80yuan; expenses of examination accounted for26.24%with a median of895.75yuan; expenses of surgery accounted for9.12%with a median of0.00yuan; expenses of treatment accounted for9.97%with a median of178.14yuan; expenses of bed accounted for4.89%with a median of160.00yuan.3. CV was used for measuring the variation degree of expenses within the group and the minimum was5.59%, maxmum was111.50%, average was81.55%, which illustrated good homogeneity within the group. The difference of hospitalization total fee between DRGs groups had statistical significance by Kruskal-Wallis H test, P<0.001. Since length of stay and total fee of hospitalization are two important indicators to measure the consumption of health resources, unicariate analysis was done for the factors affecting them. For sex aspects, the length of stay and total fee of hospitalization of male patients were both higher than female. For age aspects, older the patients were, longer the length of stay and higher the total fee of hospitalization. For whether surgical or not aspects, the length of stay and total fee of hospitalization of surgical patients were both higher than medical. For disease severity aspects, more serious the diseases were, longer the length of stay and higher the total fee of hospitalization in general. For number of diagnosis and surgery aspects, more the diagnosis and surgery were longer the length of stay and higher the total fee of hospitalization in general.4. The average length of stay of digestive diseases inpatients in four public hospitals in Yunan Province during2009-2010was11.82days, all hoapitals in Thailand was5.71days. The difference of length of stay between Yunnan and Thailand had statistical significance by Wilcoxon signed rank test, P<0.001. The average length of stay in Thailand was less than Yunnan.5.38cases of surgical were unrelated to principal diagnosis.497cases could not be grouped including43cases whose primary and secondary were the same,5cases whose surgery code were untrue,252cases of newborn lack of admission weight.Conclusions This grouping is reasonable. DRGs can reduce the consumption and guide the rational use of health resources. Medical information systems of four hospitals are not uniform. Writing on the inpatient records of four hospitals were incomplete and not standadized. Thai DRGs methodology is not fully applicable to the actual situation in Yunnan Province.SuggestionsYunnan Province should develop Yunnan version of DRGs acoording to the actual medical situation. Specific suggestions include attach great importance to the policy and work out relevant laws and regulations; set a research team for Yunnan version of DRGs; integrate hospital information systems and train coders; establish a scientific disease costing system; improve the clinical pathway management system and doctors incentives; supervise the implementation of DRGs in medical institutions.