Potena A, Ballerin L, Putinati S, Piattella M, Cellini M, Buniolo C, Cavalli A, Rampulla C, Gorini M, Corrado A, Confalonieri M
Div. Respiratory Physiopathology, Azienda Arcispedale S. Anna of Ferrara, Italy.
Monaldi Arch Chest Dis. 2004 Jan-Mar;61(1):14-8.
To date we lack official data on tipology of Diagnosis Related Groups (DRGs) and their quality in Italian Respiratory Intermediate Care Units (RICUs).
The objective of the study was to collect data on the activity of 26 Italian RICUs and to evaluate the quality of the DRGs generated.
The primary and secondary diseases, the procedures carried out and their coding using the ICD9 system (valid Italy until 2000) were collected from the discharge forms of patients admitted to RICUs. To obtain the DRG, these codes were automatically recoded in the ICD9-CM classification system by Grouper 10. Afterwards, the same diseases and procedures were directly processed by the ICD9-CM classification system. Finally, in order to evaluate the quality of care, the DRGs generated by the ICD9 classification system were compared to DRGs generated by the ICD9-CM classification system.
The average weight of the patients cared for in an Italian RICU was 2.05 using the ICD9 classification system and 2.53 using the ICD9-CM classification system. Some non-complicated DRGs (80-97) or non specific DRGs (101-102) were set to zero; others, like DRG 87 appear due to the ability of the ICD9-CM classification system to recognise and accept the fifth digit of the Respiratory Failure code (518.81). The difference in terms of DRG scores generated by the two codification systems was 360.5 DRG points in favour of ICD9-CM. More than 1 million Euro of reimbursements have been lost, as the average national reimbursement for each DRG score is Euro 2,943.80.
Severe pulmonary diseases determined the case mix of patients cared for in the Italian RICUs during the observed period. The Italian RICUs offer high quality assistance and are characterised by high mean weight per treated patient. However, the activity has been under-estimated due to the low sensitivity of the ICD9 classification system used in the recognition of the real disease and in the correct generation of relative DRG. The ICD9 classification system penalised the recognition of respiratory failure in particular.
迄今为止，我们缺乏意大利呼吸中间护理病房（RICUs）的诊断相关组（DRGs）类型及其质量的官方数据。
本研究的目的是收集26家意大利RICUs的活动数据，并评估所生成DRGs的质量。
从RICUs收治患者的出院表格中收集原发性和继发性疾病、所实施的程序及其使用ICD9系统（2000年前在意大利有效）的编码。为了获得DRG，这些编码由Grouper 10在ICD9-CM分类系统中自动重新编码。之后，相同的疾病和程序由ICD9-CM分类系统直接处理。最后，为了评估护理质量，将ICD9分类系统生成的DRGs与ICD9-CM分类系统生成的DRGs进行比较。
使用ICD9分类系统时，意大利RICUs护理患者的平均权重为2.05，使用ICD9-CM分类系统时为2.53。一些非复杂DRGs（80 - 97）或非特定DRGs（101 - 102）被设为零；其他的，如DRG 87出现是由于ICD9-CM分类系统能够识别和接受呼吸衰竭代码（518.81）的第五位数字。两种编码系统生成的DRG分数差异为360.5个DRG点，有利于ICD9-CM。由于每个DRG分数的全国平均报销额为2943.80欧元，因此损失了超过100万欧元的报销费用。
在观察期内，严重肺部疾病决定了意大利RICUs护理患者的病例组合。意大利RICUs提供高质量护理，其特点是每位接受治疗患者的平均权重较高。然而，由于所使用的ICD9分类系统在识别实际疾病和正确生成相关DRG方面敏感性较低，该活动被低估。ICD9分类系统尤其不利于呼吸衰竭的识别。
