Refined DRGs: trials in Europe.

DRGs have recently been revised to account for severity of illness through a more refined use of additional diagnoses (comorbidities and complications). Under the refined model, patients are differentiated with respect to classes of additional diagnoses that are disease and procedure specific. The Refined DRGs were evaluated with data from selected Barcelona hospitals and the findings compared to those obtained with Norwegian and English hospital discharge information. In terms of predictive performance, the Refined DRGs represent only a very small improvement over the second revision DRGs for the study's sample of European data. This lack of significant improvement is likely attributed to misclassification of the European discharges due to limited reporting of additional diagnoses. It is recommended that European countries use the Refined DRGs as a descriptive framework for reporting utilization statistics in order to encourage more complete reporting of comorbidities and complications.