Kim Sujeong, Choi Byoongyong, Lee Kyunghee, Lee Sangmin, Kim Sukil
Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University, Main building No. 223, 222 Banpodaero, Seoul, Korea.
Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
Health Res Policy Syst. 2021 Jun 29;19(1):98. doi: 10.1186/s12961-021-00739-5.
To evaluate the performance of the patient clinical complexity level (PCCL) mechanism, which is the patient-level complexity adjustment factor within the Korean Diagnosis-Related Groups (KDRG) patient classification system, in explaining the variation in resource consumption within age adjacent diagnosis-related groups (AADRGs).
We used the inpatient claims data from a public hospital in Korea from 1 January 2017 to 30 June 2019, with 18 846 claims and 138 AADRGs. The differences in the total average payment between the four PCCL levels for each AADRG was tested using ANOVA and Duncan's post hoc test. The three patterns of differences with R-squared were as follows: the PCCL reflected the complexity well (valid); the average payment for PCCL 2, 3, and 4 was greater than PCCL 0 (partially valid); the PCCL did not reflect the complexity (not valid).
There were 9 (6.52%), 26 (18.84%), and 103 (74.64%) ADRGs included in the valid, partially valid, and not valid categories, respectively. The average R-squared values were 32.18, 40.81, and 35.41%, respectively, with an average R-squared for all patterns of 36.21%.
Adjustment using the PCCL in the KDRG classification system exhibited low performance in explaining the variation in resource consumption within AADRGs. As the KDRG classification system is used for reimbursement under the new DRG-based prospective payment system (PPS) pilot project, with plans for expansion, there should be an overall review of the validity of the complexity and rationality of using the KDRG classification system.
韩国诊断相关分组（KDRG）患者分类系统中的患者临床复杂程度水平（PCCL）机制作为患者层面的复杂性调整因子，本研究旨在评估其在解释年龄相邻诊断相关分组（AADRG）内资源消耗差异方面的表现。
我们使用了韩国一家公立医院2017年1月1日至2019年6月30日的住院患者理赔数据，共有18846份理赔记录和138个AADRG。使用方差分析和邓肯事后检验对每个AADRG的四个PCCL水平之间的总平均支付差异进行了检验。与决定系数（R²）相关的三种差异模式如下：PCCL能很好地反映复杂性（有效）；PCCL 2、3和4的平均支付高于PCCL 0（部分有效）；PCCL不能反映复杂性（无效）。
有效、部分有效和无效类别分别包含9个（6.52%）、26个（18.84%）和103个（74.64%）AADRG。平均R²值分别为32.18%、40.81%和35.41%，所有模式的平均R²为36.21%。
在KDRG分类系统中使用PCCL进行调整，在解释AADRG内资源消耗差异方面表现不佳。由于KDRG分类系统用于新的基于诊断相关分组的前瞻性支付系统（PPS）试点项目下的报销，且有扩大计划，因此应全面审查KDRG分类系统复杂性的有效性和使用的合理性。
