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D Hindle

Publications and source records attributed to D Hindle.

48 records · Page 3Linked to original sources
PubMed1993

Do diagnosis related groups separate the case-mix of a specialist children's hospital and a paediatric unit in a general hospital?

The ability of diagnosis related groups (DRG) and refinement diagnosis related groups (RDRG) to measure differences in case-mix was investigated using discharge data for patients < 18 years of age from three specialist children's hospitals and four district hospitals. While the three children's hospitals each had a greater percentage of RDRG for more complex patients, only one children's hospital had more complex patients based on DRG and RDRG cost weights and on the percentage of diagnoses per discharge. Cost weights based on USA practices may be inappropriate in Australia, and Australian weights will be necessary for firm conclusions. Refinement diagnosis related groups with appropriate cost weights may be acceptable measures of case-mix in specialist children's hospitals, but they have inherent limitations for paediatric patients in that many complex paediatric patients are ill very seriously with one disorder, whereas complex adult patients usually have secondary diagnoses and secondary procedures. Moreover, no DRG version developed in the US will be suitable for use in Australia unless it takes account of medical costs and transfer practice.

Adolescent↗
PubMed1993

Computerised care plans: provoking a quiet revolution.

The Illawarra Area Health Service has been experimenting with use of computerised nursing care plans. Microcomputer software has been successfully tested in several wards and the intention is to move to implementation which will probably involve porting the software to the area-wide mainframe. The technology was recently extended to multidisciplinary care planning using the managed care/critical pathways approach. This paper describes the development process and some of the initial results.

Australia↗
PubMed1993

The Australian National Non-Acute Inpatient Project.

The Australian National Non-Acute Inpatient Project has produced a casemix classification system for non-acute inpatients (NAIP). The daily classification has 19 final classes which bring together descriptions of a patient's clinical type (from admission diagnosis) and functional ability (from automated nursing care plans). Data on salary cost relating to care of 786 patients were collected at three large metropolitan teaching hospitals for six months during 1991, yielding a total sample of 15,013 non-acute bed-days. The NAIP classification was built from first principles, combining clinician input and statistical testing using an analysis of variance model (PC Grouper). Overall variance reduction on the full set of 15,013 records was 26.15 per cent.

Activities of Daily Living↗
PubMed1992

Casemix classification and Australian doctors. Risks and opportunities.

"Casemix" is an information tool--a set of patient care classifications and ideas about their use. It is useful only if it promotes understanding, and leads to better performance of the health system. Here we discuss some uses of casemix classifications, including payment of hospitals on a per case basis. Clinicians need to be concerned about both the design of casemix classifications themselves, and the ways in which they are used.

Australia↗
PubMed1991

Where are DRGs going?

The diagnosis related groups (DRG) classification of acute inpatient episodes was developed in the United States to meet the perceived needs of the U.S. hospital sector. Thus far, it has been used in Australia without significant modification. In this paper, we assess the DRG system in terms of basic principles of classification design and suggest some possible revisions which might be considered if there were reason to contemplate major changes for Australia. We conclude by making some suggestions on the process of managing the development of DRGs in Australia.

Acute Disease↗
PubMed1991

The problem of neonatal diagnosis related groups.

There is, as yet, no satisfactory set of Diagnosis Related Groups to measure the casemix and consumption of hospital resources in the care of newborn infants. To obtain further information, infants less than 28 days when admitted to the Royal Children's Hospital and Royal Women's Hospital, Melbourne were analysed. Both Refined Diagnosis Related Groups and Pediatric Modified Diagnosis Groups were used. Neonatal groups of the Pediatric Modified system included all infants aged less than 28 days on admission, whereas Refined Diagnosis Related Groups includes only those newborn infants who have diagnoses specific to the newborn period. Refined Diagnosis Related Groups and their higher order contained 1,237 discharges. Standard deviation and coefficient of variation and length of stay in these RDRG were high. However, if the patients in these RDRGs were further grouped according to PMDRGs, there appeared to be more homogeneous missing. The R2 values were four times higher. It is recommended that a satisfactory form of neonatal DRGs is to regroup patients in neonatal RDRGs through a PMDRG grouper.

Australia↗
PubMed1990

The refined diagnosis related groups system: an early look at its potential for Australia.

The DRG patient classification system is widely used in Australia, and its use is likely to increase. However, it has some weakness, including the failure to adequately take account of variations in resource use among patients in the same classes. A new version, called the Refined DRG (or RDRG) system became available in January 1989. Inter alia, it makes better use of data on secondary diagnoses; and defines three or four levels of resource use intensity for all major types of conditions, rather than just two levels for fewer types of conditions. The new system is briefly described. Some preliminary results of its use on Australian data are presented, which suggest that it does have advantages in terms of increased homogeneity of resource use in classes. If the RDRG system is to replace the DRG system as the international standard, there are some important implications for Australia. In particular, it would seem to be advisable for health agencies to plan for its imlementation on a national basis.

Australia↗
PubMed1990

Diagnosis related groups, refined diagnosis related groups and pediatric modified diagnosis related groups in specialist children's hospitals.

The value of Diagnosis Related Groups, Refinement Diagnosis Related Groups and Pediatric Modified Diagnosis Related Groups in measuring the output of specialist children's hospitals was evaluated by the examination of discharge data for 1987-88 from three major Australian children's hospitals and four district hospitals. The study included all patients aged 0-18 years but excluded those with specific neonatal diagnoses. Findings indicated that Refinement Diagnosis Related Groups seem to give a better measure of the output of specialist children's hospitals than Version 5 Diagnosis Related Groups in that they explained a higher proportion of variation of length of stay. Pediatric Modified Diagnosis Related Groups developed in the United States of America for specialist children's hospitals overall did not seem to have major advantages over Refinement Diagnosis Related Groups but there were some specific Pediatric Groups that appeared beneficial. Further modification of the Refinement Diagnosis Related Groups could allow these advantages to be incorporated. Overall it seems preferable for there to be a similar system measuring output of both children's hospitals and general hospitals and this could be achieved by some minor changes to the Refinement Diagnosis Related Groups.

Adolescent↗
PubMed1988

DRG production costs: one more dimension in management information for South Australia hospitals.

This paper summarises and discusses a report of a recent study undertaken by the South Australian Health Commission (SAHC) aimed at the measurement of the production costs of diagnosis related groups. Data were generated on an experimental basis for the seven major public hospitals in the State. The methodology was judged to be feasible, and data outputs of great potential value. It has therefore been decided that the costing process should become a routine component of the hospital management information system. Work is proceeding to extend the process to other sites. It is anticipated that production costs data of these types will make significant contributions to clinical program management, facilities planning, and hospital budgeting decisions in the future.

Accounting↗
PubMedDate not supplied

The effectiveness of AN-DRGs in classification of acute admitted patients with diabetes.

The Australian National Diagnosis Related Groups (AN-DRGs) classification is intended to assign acute admitted patient episodes to classes which are iso-resource and clinically homogeneous. It has been widely used to good effect, but its performance has been questioned with respect to the classification of patients with chronic conditions. The primary aim of this study was to investigate the extent to which AN-DRGs classify episodes of care for a chronic disorder (in this case diabetes) into classes which are relatively homogeneous in terms of clinical attributes and the resources used in the provision of care. The records of 2094 patients admitted during 1994-95 to four hospitals in the Illawarra Area Health Service with at least one diabetes diagnosis recorded in the discharge summary were reviewed. We found that the source data used for assignment contained errors of medical documentation, abstraction and sequencing, and coding. The sampled patients were distributed among many AN-DRGs in a way which was neither clinically coherent nor obviously descriptive of resource-use differences. The AN-DRG logic appears to ignore or otherwise under-estimate the effects of diabetes as a secondary diagnosis.

Acute Disease↗