Muñoz E, Sterman H, Goldstein J, Chalfin D, Cohen J, Wise L
Department of Medicine, Queens Hospital Center, Stonybrook.
Am Rev Respir Dis. 1988 May;137(5):998-1001. doi: 10.1164/ajrccm/137.5.998.
The purpose of this study was to analyze hospital resource consumption in the 8 noncomplicating condition-stratified pulmonary medicine diagnostic-related groups (DRGs). We analyzed 427 Medicare patients treated during a 2-yr period in these 8 noncomplicating condition-stratified DRGs. Patients with a greater number of complicating conditions (CCs) had higher total hospital costs, a longer hospital length of stay, more procedures per patient, increasing financial risk under DRGs, a larger number of outliers, and a higher mortality than did patients in these same DRGs with a fewer number of CCs. These findings raise the question of the equity of DRG reimbursement at our hospital vis-à-vis the non-CC-stratified pulmonary medicine DRGs. If these findings are generalizable at other teaching hospitals, the current DRG system may provide financial incentives to not treat certain types of pulmonary medicine patients likely to have many CCs, and potentially effect these patient's access and quality of care in the future.
本研究的目的是分析8个无并发症情况分层的肺病诊断相关分组（DRGs）中的医院资源消耗情况。我们分析了在这8个无并发症情况分层的DRGs中，2年期间接受治疗的427名医疗保险患者。与这些相同DRGs中并发症情况较少的患者相比，并发症情况较多（CCs）的患者总住院费用更高、住院时间更长、每位患者的手术更多、在DRGs下的财务风险增加、异常值数量更多且死亡率更高。这些发现引发了关于我院DRG报销相对于非CC分层的肺病DRGs的公平性问题。如果这些发现在其他教学医院具有普遍性，当前的DRG系统可能会提供经济激励，导致不治疗某些可能有许多CCs的肺病患者类型，并可能在未来影响这些患者获得医疗服务的机会和医疗质量。
