Case #317

Case 2008-MDC06-01 Peptic ulcer and hierarchy for DRG 174-178

Added by Anonymous over 5 years ago. Updated almost 5 years ago.

Status:AcceptedStart date:2007-09-06
Priority:MajorSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2008
Initiator:Sweden Target year:2009
Case type: Owner / responsible:Datawell
MDC:MDC06 Old forum status:CLOSITEM - Closed item
Target Grouper:COMMON, DEN, EST, FIN, ICE, NOR, SWE

Description

Last updated: 2008-04-07
Initiated: 2007-09-06
By: Ann Liljeström, Gotland/CPK, Sweden
Expert Network 2008-03-06 - Change recommended
Steering Group 2008-03-31 - Recommendation accepted

BACKGROUND:

CPK ID 237
Code K22.1 (Sår i esofagus) belongs to DRG 176 (Complicated peptic ulcer) with a weight of 0.8926 in Sweden 2008. If the code K92.1 (Melena) is added to K22.1 the result will be DRG 175 (GI hemorrhage w/o cc) with a weight of 0.5260.

This is obviously wrong. An addition of a complicating secondary diagnosis should not lead to a lower DRG-weight.

During the analysis of the problem CPK found that there are unnecessary many DRG’s with peptic ulcer, resulting in few cases per DRG, se table below. DRG 176 and DRG 177 can be fused into one new group since the weights are almost the same for these groups.

Analysis

Suggestion

1. DRG 176 and DRG 177 are fused into one new group that can be called DRG 176N ‘Peptic ulcer, complicated or w cc’.
2. The hierarchy among DRG 174-178 is changed into the following order:

COMMENTS:

Martti Virtanen 2008-02-19

All 5 groups have a high variance in the Finnish data:

The proposal from Sweden does not seem to solve much of this problem. The new combined group still has a very high variation and the total variance does not change.

It seems that to groups 174,176 and 177 combined as ‘Complex peptic ulcer or GI-haemorrhage’ and 175 and 178 as ‘Uncomplicated peptic ulcer or GI-haemorrhage’ gives as good result. It is questionable if more than 2 groups are necessary because the clinical value of the 5 separate groups is also questionable.

COMMENTS:

Expert Network 2008-03-06
This decission is missing from the NordDRG Forum.

2008-MDC06-01_1.jpg (18.6 KB) Anonymous, 2014-05-14 12:27

2008-MDC06-01_2.jpg (4.39 KB) Anonymous, 2014-05-14 12:30

2008-MDC06-01_3.jpg (28.8 KB) Anonymous, 2014-05-14 12:33

2008-MDC06-01_4.jpg (33 KB) Anonymous, 2014-05-14 12:33

History

#1 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#2 Updated by Martti Virtanen almost 5 years ago

2014-10-07 Martti Virtanen
The missing decission is as follows:

Technical change:
Two new DRG's are created
174N 'Complex peptic ulcer or GI-haemorrhage'
175N 'Uncomplicated peptic ulcer or GI-haemorrhage'

In DRGLOGIC table in the rules for DRG 174, 176 and 177 DRG is changed to 174N and in the rules for DRG 175 and 178 DRG is changed to 175N

DRG change
Cases previously assigned to DRG 174, 176 and 177 are assigned to 174N.
Cases previous assigned to DRG 175 and 178 are assigned to 175N

Introduction
NordDRG 2009

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