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Have DRG-based prospective payment systems influenced the number of secondary diagnoses in health care administrative data?

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HEALTH POLICY 2003年第2期65卷 101-107页

作者： Serdén, L Lindqvist, R Rosén, M Natl Board Hlth & Welf Ctr Epidemiol Ctr Patient Classificat Syst SE-10630 Stockholm Sweden

Diagnosis-related groups (DRGs) are secondary patient classification systems based on primary classified medical data, in which single events of care are grouped into larger, economically and medically consistent groups. The main primary classified medical data are diagnoses and surgery codes. In Sweden, the number of secondary diagnoses per case increased during the 1990s. In the early 1990s some county councils introduced DRG systems. The present study investigated whether the introduction of such systems had influenced the number of secondary diagnoses. The nationwide Hospital Discharge Register from 1988 to 2000 was used for the analyses. All regional hospitals were included, giving a database of 5,355,000 discharges. The hospitals were divided into those that had introduced prospective payment systems during the study period and those that had not. Among all regional hospitals, there was an increase in the number of coded secondary diagnoses, but also in the number of secondary diagnoses per case. Hospitals with prospective payment systems had a larger increase, starting after the system was introduced. Regional hospitals without prospect payment systems had a more constant increase, starting later and coinciding with the introduction of their DRG-based management systems. It is concluded that introduction of DRG-based systems, irrespective of use, focuses on recording diagnoses and therefore increases the number of diagnoses. Other reasons may also have contributed to the increase. It was found that the changes in the speciality mix, during the study period, have impact on the increase of secondary diagnoses. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.

关键词： DRG prospective payment system secondary diagnoses coding practice reimbursement

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Changes in the utilization of diagnostic codes in neonatology following the introduction of activity-based financing

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HEALTH POLICY 2005年第2期74卷 218-223页

作者： Hansen, TWR Univ Oslo Rikshosp Univ Hosp Dept Pediat Barneklinikken NO-0027 Oslo Norway Univ Oslo Dept Hlth Management & Hlth Econ N-0316 Oslo Norway

Activity-based financing was introduced in public hospitals in Norway in 1997. Following this, hospitals have been financed in part by block grants, in part by grants based on productivity as measured through weighted diagnosis-related groups (DRGs). Insufficient national data were available to allow for proper calculation of DRG weights for neonatology. Thus, data from other countries were used to estimate weights. It seemed of interest to examine whether the use of diagnostic codes in neonatal medicine was changed following the introduction of activity-based financing and DRGs. Data from 1994, 1996, 1998, and 2000 were obtained from the proprietary database of the NICU at Rikshospitalet, University of Oslo, as well as from the hospital Patient Information Management System. Diagnoses were organized into 39 categories, counted for each of the 4 years, and analyzed by non-parametric ANOVA. There were significant changes in the use of diagnostic categories during the 1994-2000 time period. Some diagnoses which previously have been only rarely used, became more frequent. The use of other diagnoses varied in ways that could only be understood in terms of tactical usage. It is concluded that the use of DRGs as a basis for activity-based financing may result in changes in the use of certain diagnostic categories which are not related to biological changes in the patient population. This may complicate epidemiological research. On the other hand, activity-based financing may result in increased attention to the diagnostic process, leading to increased use of secondary diagnoses and thus more complete diagnostic coding. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

关键词： DRG activity-based financing reimbursement neonatology coding practice diagnosis procedure

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Disease-Specific Trends of Comorbidity coding and Implications for Risk Adjustment in Hospital Administrative Data

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HEALTH SERVICES RESEARCH 2016年第3期51卷 981-1001页

作者： Nimptsch, Ulrike Tech Univ Berlin Sch Econ & Management Dept Struct Adv & Qual Management Hlth Care ST 0-1Steinpl 2 D-10623 Berlin Germany

Objective. To investigate changes in comorbidity coding after the introduction of diagnosis related groups (DRGs) based prospective payment and whether trends differ regarding specific comorbidities. Data Sources. Nationwide administrative data (DRG statistics) from German acute care hospitals from 2005 to 2012. Study Design. Observational study to analyze trends in comorbidity coding in patients hospitalized for common primary diseases and the effects on comorbidity-related risk of in-hospital death. Extraction Methods. Comorbidity coding was operationalized by Elixhauser diagnosis groups. The analyses focused on adult patients hospitalized for the primary diseases of heart failure, stroke, and pneumonia, as well as hip fracture. Principal Findings. When focusing the total frequency of diagnosis groups per record, an increase in depth of coding was observed. Between-hospital variations in depth of coding were present throughout the observation period. Specific comorbidity increases were observed in 15 of the 31 diagnosis groups, and decreases in comorbidity were observed for 11 groups. In patients hospitalized for heart failure, shifts of comorbidity-related risk of in-hospital death occurred in nine diagnosis groups, in which eight groups were directed toward the null. Conclusions. Comorbidity-adjusted outcomes in longitudinal administrative data analyses may be biased by nonconstant risk over time, changes in completeness of coding, and between-hospital variations in coding. Accounting for such issues is important when the respective observation period coincides with changes in the reimbursement system or other conditions that are likely to alter clinical coding practice.

关键词： Risk adjustment administrative data comorbidity Elixhauser diagnosis groups coding practice

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A Collaborative coding Platform for Both College Students and Teachers 8th

A Collaborative Coding Platform for Both College Students an...

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8th Smart Trends in Computing and Communications (SmartCom)

作者： Hingve, Himani Tembhare, Aakash Gawande, Kartiki Mandal, Aadarsh Pawar, Ritu Dorlikar GH Raisoni Coll Engn Dept Informat Technol Nagpur 440016 India

ISBN: (纸本)9789819713288;9789819713295

In the rapidly evolving field of computer science education, there is an increasing demand for a comprehensive coding platform that caters to the needs of both college students and educators Although the educational setting is vital in exposing students to computer programming, current coding practices are frequently unsatisfactory because evaluating proposed solutions takes a lot of time. The aim of this research paper is to develop an integrated web-based coding platform called "CodeConnect". This platform offers a flexible ecosystem for coding practice, assessment, and collaborative learning, with the goal of empowering educators and learners alike. It acts as a database of programming problems, providing opportunities for training, practice, and tracking of progress. Our web application aims to create a supportive community that promotes collaboration, skill development, and a passion for coding by bridging the gap between students and educators.

关键词： Code editor Web application coding practice Collaborative platform Computer programming

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THE IMPACT OF DIFFERENT coding SYSTEMS ON DRG ASSIGNMENT AND DATA

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HEALTH POLICY 1991年第2期17卷 133-149页

作者： REID, B UNIV NEW S WALES SCH HLTH SERV MANAGEMENTKENSINGTONNSW 2033AUSTRALIA

The Diagnosis Related Group (DRG) classification system is widely used to describe the casemix of acute care hospitals, making it possible to compare the casemix of hospitals from different countries. However, in order to fully understand these comparisons, it is necessary to clarify the impact which the different coding systems used in various countries may have had on the results. The DRG system is based on codes from the international Classification of Diseases 9th Revision Clinical Modification (ICD9CM). Countries which use other coding systems convert, i.e. map, their codes into the nearest ICD9CM equivalent before allocating the DRGs. The impact of mapping on both medical and surgical DRGs is discussed and new titles are given for the affected DRGs. As far as possible, problems caused by mapping are distinguished from those caused by differences in coding practices. Based on the analysis of the classification systems, the mapping tables and the resulting DRG data, it is concluded that using mapped data does not have a great impact on the DRGs. Only 37 DRGs (7.8%), 15 medical and 22 surgical classes, are affected by mapping problems. However, while the scale of these problems is not large, given the large number of different surgical classification systems currently in use in Europe, the introduction of a standard surgical classification system for Europe Is recommended.

关键词： DIAGNOSIS RELATED GROUP DISEASE AND PROCEDURE CLASSIFICATION SYSTEM INTERNATIONAL CLASSIFICATION OF DISEASES 9TH REVISION coding practice

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Making a Quality Start: A Coder Orientation Program

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Health information management : journal of the Health Information Management Association of Australia 2003年第2期31卷 12-15页

作者： Andrea Groom Andrea Groom AssocDip MRA Coding and Casemix Educator Coding and Casemix Services Southern Health Clayton VIC and Project Officer National Centre for Classification in Health Melbourne VIC Tel: (03) 9594 1490.

Orienting new clinical coders to the hospital's case mix should be a basic function of the organisation's coding Service. After much trial and error, Southern Health coding and Casemix Services has devised an orientation program that brings together, in a structured and logical manner, all the elements a coder needs to know. This article describes the current coding orientation program.

关键词： Classification ICD-10-AM coding practice coding productivity data quality quality control

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