Serdén Lisbeth, Lindqvist Rikard, Rosén Måns
Centre for Patient Classification Systems, Centre for Epidemiology, National Board of Health and Welfare, SE-10630 Stockholm, Sweden.
Health Policy. 2003 Aug;65(2):101-7. doi: 10.1016/s0168-8510(02)00208-7.
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 nation-wide 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.
诊断相关分组（DRGs）是基于初级分类医疗数据的二级患者分类系统，其中单次护理事件被归为更大的、经济和医学上一致的组。主要的初级分类医疗数据是诊断和手术编码。在瑞典，20世纪90年代每个病例的二级诊断数量有所增加。20世纪90年代初，一些郡议会引入了DRG系统。本研究调查了此类系统的引入是否影响了二级诊断的数量。分析使用了1988年至2000年的全国医院出院登记数据。所有地区医院都被纳入，形成了一个包含535万例出院病例的数据库。医院被分为在研究期间引入了前瞻性支付系统的医院和未引入的医院。在所有地区医院中，编码的二级诊断数量增加了，每个病例的二级诊断数量也增加了。引入前瞻性支付系统的医院增加幅度更大，是在系统引入后开始的。没有前瞻性支付系统的地区医院增加较为稳定，开始时间较晚，且与基于DRG的管理系统的引入同时发生。得出的结论是，基于DRG的系统的引入，无论是否使用，都侧重于记录诊断，因此增加了诊断数量。其他原因也可能导致了这种增加。研究发现，在研究期间专业组合的变化对二级诊断的增加有影响。
