Study On The Optimization Of Age Grouping Of Pediatric Surgery Based On CN-DRG

[Obj ective]The age grouping within pediatric diagnosis-related groups(DRG)in the CN-DRG has been scarcely explored.The aim of this study is to modify age grouping of pediatric surgery in the CN-DRG by risk-adjusted modeling.[Methods]The subjects of this study are pediatric inpatients discharged from 68 secondary and tertiary hospitals in Beijing.We merged the front page of medical records and the grouping codes of CN-DRG into dataset.Multilevel analyses were conducted to explore the associated factors of hospital costs based on the grouping in CN-DRG.Then the predicted outcomes base on multilevel were used to calculated the weight of costs in DRG.According to the results of statistical analysis and literature review,we find the age plots which help categorize pediatric inpatients,and finally tested the accuracy of age stratification by surgical DRGs.[Results]A total of 30,258 cases of 20 groups of pediatric surgical DRGs were included in this study.The results show that there are differences in hospitalization expenses among different types and grades of medical institutions,including gender,types of medical insurance,number of admission,intensive care and readmission plan,etc.After controlling such indicators,the most significant effect on hospitalization cost of DRG was medical expenses(?=-0.1924,P =<0.0001),followed by drugs and consumables(?=-0.1468,P<0.0001),nursing care expense had the least effect on total cost of hospitalization(?=-0.0271,P<0.0001).20 DRGs had a weight value of more than 1,among which,IC10 got the maximum weight value(3.92).The median and average cost of hospitalization after adjustment were higher than those before adjustment.In terms of age changes,the median total cost of hospitalization after adjustment peaked at 1 and 13 years old,and was low at three age points,including 0,2 and 16 years old.The inflection point of average adjusted cost was at 7 and 14 years old.Compared with the cost between 0 to 7 years old,the total cost of hospitalization rapidly raised from 7 to 14 years old.From the age of 14,the total cost firstly decreased and then increased.According to the results of cluster analysis on adjusted-cost difference,the total sample was divided into three age intervals,including 0 to 3years old,3 to 13 years old and 13 to 17 years old.The age node of DG20 was the same as that of the whole sample,while the IH26 was divided into 0 to 3years old and 3 to 17 years old.[Conclusions]DRG grouping is mainly based on clinical characteristics and resource consumption.Whether hospitalization medical expenses can reflect the actual medical cost of disease is the key of DRG grouping.Therefore,optimizing the cost structure is an important prerequisite for the scientific grouping of DRG.The findings of this study indicate that considering the various characteristics of diseases,treatment and resource consumption,the age grouping of diagnoses related groups for pediatric surgery in the CN-DRG should be refined and divide into different age groups.