Health Economics, Hospital's Management and Nursing research Department, CP592- School of Public Health, Université Libre de Bruxelles, 808, Route de Lennik, B- 1070, Bruxelles, Belgium.
BMC Nurs. 2013 Oct 10;12(1):26. doi: 10.1186/1472-6955-12-26.
As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to evaluate if nursing activity is homogeneous by APR-DRG and by severity of illness (SOI) (2) to evaluate the outlier's rate associated with the nursing activity and (3) to compare nursing cost homogeneity per DRG and SOI.
Study done in 9 Belgian hospitals on a selection of APR-DRG with more than 30 patients (7 638 inpatient stays). The evaluation of the homogeneity is based on coefficients of variation (CV). The 75th percentile + 1.5 × inter-quartile range was used to select high outliers. 25th percentile -1.5 × inter-quartile range was used to select low outliers. Nursing costs per ward were distributed on inpatient stays of each ward following two techniques (the LOS vs. the number of nursing care minutes per stay).
The homogeneity of LOS by DRG and by SOI is relatively good (CV: 0.56). The homogeneity of the nursing activity by DRG is less good (CVs between 0.36 and 1.54) and is influenced by nursing activity outliers (high outliers' rate: 5.19%, low outliers' rate: 0.14%). The outlier's rate varies according to the studied variable. The high outliers' rate is higher for nursing activity than for LOS. The homogeneity of nursing costs is higher when costs are based on the LOS of patients than when based on minutes of nursing care (CVs between 0.26 and 1.46 for nursing costs based on LOS and between 0.49 and 2.04 for nursing costs based on minutes of nursing care).
It is essential that the calculation of nursing cost by stay and by DRG for hospital financing purposes was based on nursing activity data, that more reflect resources used in wards, and not on LOS data. The only way to obtain this information is the generalization of computerized nursing files.
自诊断相关分组 (DRG) 在许多医院的融资系统中引入以来，大多数护理研究表明，DRG 在护理方面并不完全一致。然而，很少有研究基于所有患者细化诊断相关分组 (APR-DRG)，也很少有研究使用最新数据。本研究的目的是：(1) 评估 APR-DRG 和疾病严重程度 (SOI) 对护理活动的同质性；(2) 评估与护理活动相关的离群值率；(3) 比较按 DRG 和 SOI 划分的护理成本同质性。
本研究在比利时的 9 家医院进行，选择 APR-DRG 中患者超过 30 人的病例进行研究（7638 例住院患者）。同质性评估基于变异系数 (CV)。采用第 75 百分位数+1.5×四分位间距选择高离群值，采用第 25 百分位数-1.5×四分位间距选择低离群值。每个病房的护理成本根据住院患者分布在每个病房的护理时间（住院天数 vs. 护理分钟数/住院天数）。
DRG 和 SOI 之间的住院天数同质性相对较好（CV：0.56）。DRG 之间护理活动的同质性较差（CV 值在 0.36 到 1.54 之间），并且受到护理活动离群值的影响（高离群值率：5.19%，低离群值率：0.14%）。离群值率因研究变量而异。护理活动的高离群值率高于住院天数。基于患者住院天数的护理成本比基于护理分钟数的护理成本具有更高的同质性（基于住院天数的护理成本 CV 值在 0.26 到 1.46 之间，基于护理分钟数的护理成本 CV 值在 0.49 到 2.04 之间）。
为了医院融资目的，按住院和 DRG 计算护理成本，必须基于更能反映病房资源使用情况的护理活动数据，而不是基于住院天数数据。获得此信息的唯一方法是推广计算机化护理档案。
