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PubMed · 1579945

[Diagnosis-related groups--possibilities and problems].

Abstract

Classification of patients into Diagnosis-Related Groups (DRGs) provides several opportunities in the field of hospital management. The author describes some of these opportunities and discusses the associated problems. The benefit to be obtained from using DRGs depends to a large extent on future improvements in the quality of the input data. This classification will not completely satisfy the need for information on activities in hospitals. We should be aware of the problems associated with the use of DRG, but should simultaneously recognize the potential of the system to provide better information on hospital performance. Use of DRG as a basis for hospital financing seems to be an important factor which might help to improve the quality of the data. Objections to this classification have not resulted in other generally acceptable methods of grouping patients.

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BibTeXRIS

O V Slåttebrekk. 1992-03-30. [Diagnosis-related groups--possibilities and problems].. https://pubmed.ncbi.nlm.nih.gov/1579945/

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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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