诊断相关分组系统的引入对极低出生体重儿入院权重分布的影响。

Effect of the introduction of diagnosis related group systems on the distribution of admission weights in very low birthweight infants.

机构信息

Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Heinrich-Heine-University, Moorenstrasse 5, Duesseldorf, Germany.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2011 May;96(3):F186-9. doi: 10.1136/adc.2010.192500. Epub 2010 Oct 30.

DOI:10.1136/adc.2010.192500

PMID:21037282

Abstract

BACKGROUND

Admission weight to neonatal intensive care units is used in several diagnosis related group (DRG) systems to assess reimbursement by health insurance programs for premature infants. Modifications of admission weights could significantly affect reimbursement in either direction.

OBJECTIVE

Whether the introduction of the German DRG system in 2004 influenced the distribution of admission weights of premature infants was investigated.

DESIGN/METHODS: All very low birthweight infants in the most heavily populated German federal state, North Rhine-Westphalia, born in 1999-2001 and 2004-2006, were investigated. Data were retrieved from the medical association of North Rhine-Westphalia on 13 180 very low birthweight infants (VLBW; birth weight <1500 g). These data included admission weight and gestational age.

RESULTS

In 2004-2006 compared to 1999-2001, there were significantly more infants with admission weights below 1000 g (2004-2006; 949-999 g: 460 infants, p=0.007) and 1500 g (2004-2006; 1449-1499 g: 815 infants, p=0.0019), and fewer infants with documented weights above these cut-off values (1999-2001; 1000-1049 g: 346 infants and 2004-2006; 1500-1549 g: 658 infants).

CONCLUSIONS

The introduction of the DRG system in Germany has affected the distribution of admission weights of premature infants. Potential reasons for this effect including upcoding are discussed.

摘要

背景

入院体重被用于多个诊断相关分组（DRG）系统，以评估医疗保险计划对早产儿的报销。入院体重的调整可能会对报销金额产生显著影响。

目的

本研究旨在调查 2004 年德国引入 DRG 系统是否影响了早产儿入院体重的分布。

设计/方法：本研究调查了德国人口最多的北莱茵-威斯特法伦州所有出生于 1999-2001 年和 2004-2006 年、出生体重<1500g 的极低出生体重儿（VLBW）。从北莱茵-威斯特法伦州医学协会获取了 13180 例 VLBW 患儿的数据，包括入院体重和胎龄。

结果

与 1999-2001 年相比，2004-2006 年入院体重<1000g（2004-2006 年；949-999g：460 例，p=0.007）和 1500g（2004-2006 年；1449-1499g：815 例，p=0.0019）的患儿比例显著增加，而入院体重>这些截断值的患儿比例显著减少（1999-2001 年；1000-1049g：346 例和 2004-2006 年；1500-1549g：658 例）。