Berki S E, Schneier N B
Pediatrics. 1987 Jun;79(6):874-81.
Analysis of outliers, as defined by the Health Care Financing Administration, among 47,776 newborns discharged from 33 short-term hospitals in Maryland in 1981 shows that the three prematurity diagnosis-related groups (DRGs) (386 to 388) represented only 5.3% of all discharges of newborns, but more than one fifth of all outliers and more than three fifths of outlier days of care for newborns. The disparity in charges for outliers and inliers (not exceeding the "trim point") is even more dramatic. Newborns with "extreme immaturity" (DRG 386) and "prematurity with major problems" (DRG 387) together accounted for less than 3% of all newborn discharges but for nearly one fourth of all outlier discharges. The mean length of stay in hospitals for outliers in those two DRGs was more than 2 months. The mean charge per outlier discharge in DRG 386 was $27,061 in 1981. Nearly one third of the discharges and more than two thirds of the days of care in this DRG were for outliers. Outliers occurred up to five times more often among premature neonates than among normal newborns and occurred preponderantly in teaching hospitals, especially those with more than 400 beds. This finding may require a reevaluation of the outlier trim points and the reimbursement method for newborn DRGs to assure adequate payment to the providers of neonatal intensive care, mainly large teaching hospitals.
1981年，对马里兰州33家短期医院出院的47776名新生儿进行了医疗保健财务管理局所定义的异常值分析。结果显示，三个早产诊断相关组（DRG）（386至388）仅占所有新生儿出院病例的5.3%，但却占所有异常值病例的五分之一以上，以及新生儿异常值护理天数的五分之三以上。异常值病例和非异常值病例（不超过“修剪点”）在费用上的差距更为显著。“极度不成熟”（DRG 386）和“伴有重大问题的早产”（DRG 387）的新生儿加起来占所有新生儿出院病例的不到3%，但却占所有异常值出院病例的近四分之一。这两个DRG组中异常值病例的平均住院时间超过2个月。1981年，DRG 386中每个异常值出院病例的平均费用为27061美元。该DRG组中近三分之一的出院病例和超过三分之二的护理天数属于异常值病例。早产新生儿出现异常值病例的频率比正常新生儿高出五倍，且主要出现在教学医院，尤其是床位超过400张的医院。这一发现可能需要重新评估异常值修剪点以及新生儿DRG的报销方法，以确保向新生儿重症监护服务提供者（主要是大型教学医院）提供足够的费用支付。
