The Catholic University, Korea.
Inje University, Korea.
Health Inf Manag. 2020 Jan;49(1):62-68. doi: 10.1177/1833358318795804. Epub 2018 Aug 29.
The Korean Diagnosis-Related Groups (KDRG) was revised in 2003, modifying the complexity adjustment mechanism of the Australian Refined Diagnosis-Related Groups (AR-DRGs). In 2014, the Complication and Comorbidity Level (CCL) of the existing AR-DRG system was found to have very little correlation with cost.
Based on the Australian experience, the CCL for KDRG version 3.4 was reviewed.
Inpatient claim data for 2011 were used in this study. About 5,731,551 episodes, which had one or no complication and comorbidity (CC) and met the inclusion criteria, were selected. The differences of average hospital charges by the CCL were analysed in each Adjacent Diagnosis-Related Group (ADRG) using analysis of variance followed by Duncan's test. The patterns of differences were presented with in three patterns: The CCL reflected the complexity well (VALID); the average charge of CCL 2, 3, 4 was greater than CCL 0 (PARTIALLY VALID); the CCL did not reflect the complexity (NOT VALID).
A total of 114 (19.03%), 190 (31.72%) and 295 (49.25%) ADRGs were included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average for hospital charge of CCL was 4.94%. The average in VALID, PARTIALLY VALID and NOT VALID was 4.54%, 5.21%, and 4.93%, respectively.
The CCL, the first step of complexity adjustment using secondary diagnoses, exhibited low performance. If highly accurate coding data and cost data become available, the performance of secondary diagnosis as a variable to reflect the case complexity should be re-evaluated.
Lack of reviewing the complexity adjustment mechanism of the KDRG since 2003 has resulted in outdated CC lists and levels that no longer reflect the current Korean healthcare system. Reliable cost data (vs. charge) and accurate coding are essential for accuracy of reimbursement.
韩国诊断相关分组（KDRG）于 2003 年进行了修订，修改了澳大利亚精细化诊断相关分组（AR-DRGs）的复杂性调整机制。2014 年，发现现有 AR-DRG 系统的并发症和合并症级别（CCL）与成本相关性很小。
基于澳大利亚的经验，对 KDRG 第 3.4 版的 CCL 进行了回顾。
本研究使用了 2011 年的住院患者索赔数据。选择了约 5731511 例符合纳入标准的单一或无并发症和合并症（CC）的病例。采用方差分析和邓肯检验，分析了每个相邻诊断相关分组（ADRG）中 CCL 对平均住院费用的差异。结果以三种模式呈现：CCL 很好地反映了复杂性（有效）；CCL2、3、4 的平均费用大于 CCL0（部分有效）；CCL 未反映复杂性（无效）。
共有 114（19.03%）、190（31.72%）和 295（49.25%）个 ADRG 分别归入有效、部分有效和无效类别。CCL 对住院费用的平均 为 4.94%。有效、部分有效和无效类别的平均 分别为 4.54%、5.21%和 4.93%。
作为使用次要诊断进行复杂性调整的第一步，CCL 表现不佳。如果有准确的编码数据和成本数据，应重新评估将次要诊断作为反映病例复杂性的变量的性能。
自 2003 年以来，KDRG 中复杂性调整机制未进行审查，导致过时的 CC 列表和级别不再反映当前韩国医疗保健系统的情况。可靠的成本数据（相对于费用）和准确的编码对于报销的准确性至关重要。
