Kreis D J, Augenstein D, Civetta J M, Gomez G, Vopal J J, Byers P M
Surg Gynecol Obstet. 1986 Dec;163(6):539-42.
We reviewed 59 patients with trauma treated in the surgical intensive care unit (SICU) in 1983 comparing hospital charges with payments calculated from diagnosis-related groups (DRG). There were 37 male and 22 female patients with a mean age of 38.3 years. The mechanism of injury was blunt trauma in 42 and penetrating injury in 17 patients. The mean injury severity score (ISS) was 30.7 +/- 13.8 (mean plus or minus standard deviation). The duration of SICU care was 5.4 +/- 6.1 days. Over-all, 18 patients died. For the entire group, payment based upon a DRG system would have resulted in an over-all loss of $1,468,094.00 or $24,883.00 dollars per patient. Calculated DRG payments would have accounted for only 32.3 per cent of the total hospital charges. Calculated losses for 41 survivors would have been $1,098,431.00 dollars. Length of stay had a significant relationship to the calculated DRG payment (r = 0.69, p less than 0.001) but account for only 48 per cent of the variance. DRG only accounted for 26 per cent of the variance in charges despite a statistically significant relationship (r = 0.51, p less than 0.001). No statistically significant relationship was found between ISS and hospital charge by linear regression (r = 0.20, p greater than 0.01) or between ISS and DRG payment (r = 0.14, p less than 0.4). DRG as presently formulated would only pay one-third of total hospital charges for patients with trauma requiring SICU care. Present DRG payment schedules reflect neither the elements of care currently expended nor the modifiers necessary to adjust for acuity and severity. The ISS score would not be a useful modifier to correct DRG payment in this high cost group.
我们回顾了1983年在外科重症监护病房（SICU）接受治疗的59例创伤患者，比较了医院收费与根据诊断相关分组（DRG）计算的费用。其中男性37例，女性22例，平均年龄38.3岁。损伤机制为钝性创伤42例，穿透性损伤17例。平均损伤严重度评分（ISS）为30.7±13.8（均值±标准差）。SICU护理时间为5.4±6.1天。总体而言，18例患者死亡。对于整个组，基于DRG系统的支付将导致总体损失1,468,094.00美元，即每位患者损失24,883.00美元。计算得出的DRG支付仅占医院总收费的32.3%。41名幸存者的计算损失为1,098,431.00美元。住院时间与计算得出的DRG支付有显著关系（r = 0.69，p < 0.001），但仅占方差的48%。尽管存在统计学显著关系（r = 0.51，p < 0.001），DRG仅占费用方差的26%。通过线性回归发现ISS与医院收费之间无统计学显著关系（r = 0.20，p > 0.01），ISS与DRG支付之间也无统计学显著关系（r = 0.14，p < 0.4）。目前制定的DRG仅支付需要SICU护理的创伤患者医院总收费的三分之一。目前的DRG支付时间表既未反映当前所花费护理的要素，也未反映用于调整急症和严重程度所需的修正因素。在这个高成本组中，ISS评分不是纠正DRG支付的有用修正因素。
