Case 2013-MDC14-04 - Splitting DRG 379 'Threatend abortion'
|MDC:||MDC14||Owner / responsible:||National organisations|
|Target Grouper:||Old forum status:|
Initiator: Helsinki University Hospital
Expert Network 2013-03-12: No change recommended, further work needed
Board 2013-03-27: No Change
Finnish national DRG-center got several proposals from Helsinki University Hospital with respect that DRGs in MDC 14 should be revised and analyzed. The main problem was related to DRG 373 also other groups were considered problematic.
During several meetings a working-group of clinical and economical experts was revised all DRGs in MDC 14 and came up with 6 proposals.
The analysis was performed on cases in MDC 14 in a combined data from year 2011 in all five Finnish university hospitals. For grouping Finnish 2011 Full version was used, in case of DRG 379 CC-grouper was used.
Splitting DRG 379
In DRG 379 Threatened abortion, the cost of the cases differ remarkable depending on the length of stay. At the same time the cost also differ depending on presented complications and comorbidities. The analysis was conducted based on these two different indicators. We observed that the difference between cases with LOS ≤5 and >5 is remarkable. However the variation coefficient in first case is unacceptably high.
Therefore the further analysis was carried out and the influence of LOS within DRG 379N and 379C measured.
As a consequence we present the results to NCC for further discussion in expert network regarding possible changes in grouping logic.
Swedish comment 2013-03-07
It is natural that cases with longer hospital stay are more expensive than those with a shorter stay, and that can surely be observed in many DRGs, especially in conservative groups. We do not support a DRG split based on LOS however, because that is against common DRG principles. The cases with longer stay often also have secondary diagnoses with CC so a CC split is more appropriate in the DRG system. Furthermore, a very long hospital stay often ends up as a cost outlier.
Expert group – 2013-03-12
The expert group is in principal against creating length of stay based limits to NordDRG although a few exist. However, the problem is common to all countries and a need for improvement of the grouping is obvious. Further analysis is necessary. A new working group is needed? The case was postponed.
Comment Finnish National DRG Centre Kristiina Kahur / Minna-Liisa Sjöblom 2014-02-18:
After having reviewed and analysed the case we decided not to go on with further analysis and suggest closing the case.