MacKenzie E J, Steinwachs D M, Ramzy A I, Ashworth J W, Shankar B
Health Services Research and Development Center, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
Health Serv Res. 1991 Apr;26(1):5-26.
Uniform hospital discharge abstract data from Maryland were used to examine the homogeneity of trauma-related DRGs with respect to a well-established measure of injury severity, the Injury Severity Score (ISS). Thirty DRGs were identified as including trauma cases with a wide range of severity; for each of these DRGs, ISS explains a significant amount of variation in length of stay. By applying statistical techniques similar to those used to create the original DRG groupings, these 30 DRGs were subdivided by severity and age categories to create a new set of severity-modified DRGs. The potential effects of using DRGs and modified DRGs to pay for inpatient care within the Maryland state regionalized system of trauma care were examined. Payments based on regional averages per DRG and per modified DRG were compared to actual hospital charges regulated by the state's Health Services Cost Review Commission. Using average charges per DRG as a basis of payment, approximately !1.4 million (11 percent of total hospital charges) would be shifted from trauma centers to nontrauma centers. This shift represents an 18 percent loss in revenues to trauma centers and a 30 percent gain in revenues to nontrauma centers. Using a payment system based on severity-modified DRGs, trauma centers would still experience a net loss in revenues and the nontrauma centers a net gain, but the total amount of the shift would be reduced from $11.4 million to $9.8 million. The results argue for the need to explore alternative payment systems not strictly based on current DRGs. Because of DRGs do not adequately reflect severity differences, using them to pay hospitals will create financial incentives that discourage regionalization of trauma care.
来自马里兰州的统一医院出院摘要数据被用于检验与一种成熟的损伤严重程度衡量标准——损伤严重度评分（ISS）相关的创伤相关诊断相关分组（DRG）的同质性。30个DRG被确定为包含严重程度范围广泛的创伤病例；对于这些DRG中的每一个，ISS解释了住院时间差异的很大一部分。通过应用与用于创建原始DRG分组的技术类似的统计技术，这30个DRG按严重程度和年龄类别进行细分，以创建一组新的严重程度修正的DRG。研究了在马里兰州创伤护理区域化系统中使用DRG和修正后的DRG支付住院护理费用的潜在影响。将基于每个DRG和每个修正后的DRG的区域平均值的支付与该州卫生服务成本审查委员会规定的实际医院收费进行了比较。以每个DRG的平均收费作为支付基础，大约140万美元（占医院总收费的11%）将从创伤中心转移到非创伤中心。这种转移代表创伤中心收入损失18%，非创伤中心收入增加30%。使用基于严重程度修正的DRG的支付系统，创伤中心仍将经历收入净损失，而非创伤中心将获得净收益，但转移的总额将从1140万美元减少到980万美元。结果表明有必要探索不完全基于当前DRG的替代支付系统。因为DRG不能充分反映严重程度差异，使用它们来支付医院费用将产生不利于创伤护理区域化的经济激励。
