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PubMed · 10312111

Case-mix, severity systems provide DRG alternatives.

T Pass
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Abstract

Since their adoption, diagnosis related groups (DRGs) have been criticized for relying too much on the principal discharge diagnosis, for not taking the secondary diagnoses into account, and for ignoring the severity of a patient's illness or illnesses. Four case-mix and severity systems, Disease Staging, Patient Management Categories, MedisGroups, and Computerized Severity of Illness, offer alternatives to DRGs by either classifying patients into diagnostic categories or producing overall case severity scores. While most hospitals are likely to continue using DRGs or whatever successor is prescribed by regulation, some may find it useful to look seriously at these alternatives as a means of measuring the consumption of healthcare resources.

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Diagnosis-Related GroupsHospital Information SystemsHumansMethodsSeverity of Illness IndexUnited StatesComparative StudyJournal Article

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T Pass. 1987. Case-mix, severity systems provide DRG alternatives.. https://pubmed.ncbi.nlm.nih.gov/10312111/

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Reliability of diagnoses coding with ICD-10.

OBJECTIVE: Reliability of diagnoses coding is essential for the use of routine data in a national health care system. The present investigation compares reliability of diagnoses coding with ICD-10 between three groups of coding subjects. METHOD: One hundred and eighteen students coded 15 diagnoses lists, 27 medical managers from hospitals 34 discharge letters, and 13 coding specialists 12 discharge letters. Agreement in principal diagnosis was assessed using Cohen's Kappa and the fraction of coincidences over the number of pairs, agreement for the full set of diagnoses with a previously developed measure p(om). RESULTS: Kappa values were fair (managers) or moderate (coders) for terminal codes with 0.27 and 0.42 (agreement 29.2% versus 46.8%), substantial for the chapter level with 0.71 and 0.72 (agreement 78.3% versus 80.8%). p(om) was lower for the full set of diagnoses than for principal diagnoses, for example in case of managers with 0.21 versus 0.29 for terminal codes. Best results were achieved by students coding diagnoses lists. In summary, the results are remarkably lower than in earlier publications. CONCLUSION: The refinement of the ICD-10 accompanied by innumerous coding rules has established a complex environment that leads to significant uncertainties even for experts. Use of coded data for quality management, health care financing, and health care policy requires a remarkable simplification of ICD-10 to receive a valid image of health care reality.

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