| Objective: This study compared and analyzed the two mature and representative DRG groupings in China.The study conducted an empirical analysis by selecting the front page of the medical record data of the digestive system diseases in three tertiary hospitals in city A in 2016.On the basis of clinical similarity and resource consumption,compare the grouping effects of the two programs and analyze the basic situation and grouping characteristics of the two programs to discovering the reasons for the effect of grouping,and proposing policy suggestions to optimize and improve the existing grouping scheme,provide evidence-based reference for the development and improvement of the diagnostic related groups(DRG)scheme in China,and at the same time,provides a basis for the evaluation path of DRG grouping schemes in the future.Methods: This article selects relevant data and information on the front page of the medical record,and compares the grouping results of the two grouping schemes according to the four levels of grouping logic.According to the functions and characteristics of each level,different methods are used for systematic and detailed comparative studies.For the basic information ofhospitals and patients,statistical description methods and rank sum tests are used.For the grouping effect,at the major diagnostic category(MDC)level,the statistical description method is mainly used;at the treatment mode level,since the data does not conform to the normal distribution,the Wilcoxon rank sum test is used when comparing two samples,and Kruskal-Wallis H test is used when comparing multiple samples,Wilcoxon rank sum test was used for pairwise comparison,and Bonferroni method was used to calibrate P value;at the adjacent diagnosis related groups(ADRG)level,the main methods used included statistical description,ADRG comparison,major diagnosis and major operations group analysis;at the subgroup level,analytic hierarchy process(AHP)is used.The software used includes SPSS19.0,EXCEL,YAAHP7.5 and so on.Results: In this study,a total of 3,715 cases of digestive diseases were selected according to the grouping conditions.The patients were mostly middle-aged and elderly people.The majority of patients were hospitalized for less than 15 days,and the total cost of hospitalization was less than 10,000 yuan.The total hospitalization of patients in both hospitals was the difference in cost was statistically significant(P<0.05),the total cost of hospitalization for patients in three hospitals was ranked as hospital C > hospital A >hospital B.The grouping logic of the two DRG grouping schemes is divided into four levels,including MDC,treatment mode,ADRG and subgroup.The effect of four levels of grouping is:(1)In the MDC grouping,the grouping effect is: the cases are divided into 2 MDCs in the grouping scheme A,and divided into 7 MDCs in the grouping scheme B.The main problems in this section are: Problems in the major diagnosis and major operations,problems in the coding process,and cases where enrollment was not possible;(2)In the treatment mode grouping,thegrouping effect was: The difference in the total cost of hospitalization for any two groups of treatment was statistically significant(P<0.05),the total cost of hospitalization was ranked as surgical treatment group/surgical part> other surgical treatment group/nonoperative room surgical part> non-surgical treatment group/internal medicine,and this section was more reasonable;(3)In the ADRG grouping,the grouping effect is: the cases are divided into 39 ADRGs in grouping scheme A,and divided into 52 ADRGs in grouping scheme B.The main problems in this section are: different classification designs,different internal and external diseases,there are duplicate entry conditions;(4)In the subgroup grouping,the grouping effect is: the case is divided into 62 subgroups in the grouping scheme A,and the enrollment rate is 100%;the case is divided into 99 subgroups in the grouping scheme B,and the enrollment rate is 99.92%.Using the AHP to calculate the score of the group,the overall score of the grouping scheme A is 22.1939 points,and the overall score of the grouping scheme B is 13.3163 points.Conclusion: As a whole,the CV values of each group in the two grouping schemes are relatively small,and the differences between groups are large.The grouping effect is good,but there are still some problems.The problems and suggestions in this study mainly include:(1)There are problems of choose the major diagnosis and major operations or coding,and it is recommended to strengthen the quality management of medical records and unify the disease coding and operation coding;(2)There is a situation of repeated enrollment,and it is recommended to continuously improve the grouping scheme to lay the foundation for further development of DRG in China;(3)Within the scope of this study,the grouping scheme A is more reasonable,scientific,reliable than the grouping scheme B in the overall grouping design.It is proposed to formulate agrouping scheme that suits the national conditions based on the disease spectrum of our country.(4)It is necessary to strengthen the leading role of the government in the reform of the payment system so that the DRG payment reform will take the road of sustainable development.(5)Grouping scheme should carry out empirical research on scientific rationality. |
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