先天性心脏病：德国诊断相关分组系统与亚里士多德复杂度评分之间的关系。
Congenital heart disease: interrelation between German diagnosis-related groups system and Aristotle complexity score.
机构信息
Department of Paediatric Cardio-Thoracic Surgery, Congenital Cardiac Centre ('Deutsches Kinderherzzentrum'), Asklepios Clinic, Sankt Augustin, Germany.
出版信息
Eur J Cardiothorac Surg. 2010 Jun;37(6):1271-6. doi: 10.1016/j.ejcts.2009.12.024.
OBJECTIVES
The Disease-Related Groups (DRGs) system postulates that inpatient stays with similar levels of clinical complexity are expected to consume similar amounts of resources. This, applied to surgery of congenital heart disease, suggests that the higher the complexity of procedures as estimated by the Aristotle complexity score, the higher hospital reimbursement should be. This study analyses how much case-mix index (CMI) generated by German DRG 2009 version correlates with Aristotle score.
METHODS
A total of 456 DRG cases of year 2008 were regrouped according to German DRG 2009 and related cost-weight values and overall CMI evaluated. Corresponding Aristotle basic and comprehensive complexity scores (ABC and ACC) and levels were determined. Associated surgical performance (Aristotle score times hospital survival) was estimated. Spearman 'r' correlation coefficients were calculated between Aristotle scores and cost-weights. Goodness of fit 'r(2)' from derived regression was determined. Correlation was estimated to be optimal if Spearman 'r' and derived goodness of fit 'r(2)' approached 1 value.
RESULTS
CMI was 8.787 while mean ABC and ACC scores were 7.64 and 9.27, respectively. Hospital survival was 98.5%: therefore, surgical performance attained 7.53 (ABC score) and 9.13 (ACC score). ABC and ACC scores and levels positively correlated with cost-weights. With Spearman 'r' of 1 and goodness of fit 'r(2)' of 0.9790, scores of the six ACC levels correlated at best. The equation was y = 0.5591 + 0.939x, in which y stands for cost-weight (CMI) and x for score of ACC level.
CONCLUSIONS
ACC score correlates almost perfectly with corresponding cost-weights (CMI) generated by the German DRG 2009. It could therefore be used as the basis for hospital reimbursement to compensate in conformity with procedures' complexity. Extrapolated CMI in this series would be 9.264. Modulation of reimbursement according to surgical performance could be established and thus 'reward' quality in congenital heart surgery.
目的
疾病相关分组（DRG）系统假定，具有相似临床复杂性的住院患者预计将消耗相似数量的资源。这适用于先天性心脏病手术，表明手术的复杂性越高（根据亚里士多德复杂性评分估计），医院的报销就应该越高。本研究分析了德国 2009 年版 DRG 产生的病例组合指数（CMI）与亚里士多德评分的相关性。
方法
将 2008 年的 456 例 DRG 病例根据德国 2009 年版 DRG 进行重新分组，并计算相关成本权重值和总体 CMI。确定相应的亚里士多德基本和综合复杂性评分（ABC 和 ACC）和级别。估计相关的手术表现（亚里士多德评分乘以医院生存率）。计算亚里士多德评分与成本权重之间的斯皮尔曼 'r' 相关系数。从推导的回归中确定拟合优度 'r(2)'。如果斯皮尔曼 'r' 和推导的拟合优度 'r(2)' 接近 1 值，则表示相关性最佳。
结果
CMI 为 8.787，而平均 ABC 和 ACC 评分为 7.64 和 9.27。医院生存率为 98.5%：因此，手术表现达到 7.53（ABC 评分）和 9.13（ACC 评分）。ABC 和 ACC 评分和级别与成本权重呈正相关。斯皮尔曼 'r' 为 1，拟合优度 'r(2)' 为 0.9790，最佳地关联了 ACC 六个级别的评分。方程为 y = 0.5591 + 0.939x，其中 y 代表成本权重（CMI），x 代表 ACC 级别评分。
结论
ACC 评分与德国 2009 年版 DRG 生成的相应成本权重（CMI）几乎完全相关。因此，它可以用作医院报销的基础，以根据手术的复杂性进行补偿。在本系列中，推算出的 CMI 将为 9.264。可以根据手术表现调整报销，从而在先天性心脏病手术中“奖励”质量。
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