Muñoz E, Greenberg R, Dietzek A, Goldstein J, Bank S, Wise L
Division of Gastroenterology, Long Island Jewish Medical Center, New Hyde Park, New York.
Am J Gastroenterol. 1987 Dec;82(12):1250-5.
Prospective payment systems using the diagnostic related group (DRG) payment mechanism are changing the incentives offered to hospitals. We studied hospital costs of all gastroenterological (GI) patients (n = 2500) treated during a 2-yr period at our academic medical center. We showed that patients within GI DRGs could be grouped regarding hospital costs by four clinical variables: intensive care unit or emergency admission, and blood or plasma product consumption. Patients within each DRG with the variable usually had higher total hospital costs, a longer stay in the hospital, a greater number of diagnoses, more outliers, and a poorer outcome than patients without the variables. As the variables accumulated, these differences became more pronounced. This study demonstrated that hospital costs may be stratified within GI DRGs by clinical parameters that occur during the patient's hospital stay. These four variables could identify higher cost patients within a DRG; cost containment could then be directed at these patients with, hopefully, resultant savings.
采用诊断相关分组（DRG）支付机制的前瞻性支付系统正在改变给予医院的激励措施。我们研究了在我们学术医疗中心两年期间接受治疗的所有胃肠病（GI）患者（n = 2500）的医院成本。我们发现，GI DRG内的患者可根据四个临床变量对医院成本进行分组：重症监护病房或急诊入院，以及血液或血浆制品消耗。每个DRG中具有该变量的患者通常比没有该变量的患者总住院成本更高、住院时间更长、诊断数量更多、异常值更多且预后更差。随着变量的累积，这些差异变得更加明显。这项研究表明，医院成本可通过患者住院期间出现的临床参数在GI DRG内进行分层。这四个变量可以识别DRG内成本较高的患者；然后可以针对这些患者进行成本控制，有望实现成本节约。
