Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
Int J Surg. 2021 Dec;96:106173. doi: 10.1016/j.ijsu.2021.106173. Epub 2021 Nov 7.
Complete and correct documentation of diagnosis and procedures is essential for adequate health provider reimbursement in diagnosis-related group (DRG) systems. The objective of this study was to investigate whether daily monitoring and semiautomated proposal optimization of DRG coding (precoding) is associated with higher reimbursement per hospitalization day.
This parallel-group, unblinded, randomized clinical trial randomized patients 1:1 into intervention (precoding) and control groups. Between June 12 and December 6, 2019 all hospitalized patients (1566 cases) undergoing elective or emergency surgery at the department of surgery in a Swiss hospital were eligible for this study. By random sample selection, cases were assigned to the intervention (precoding) and control groups. The primary outcome was the total reimbursement, divided by the length of stay.
Of the 1205 randomized cases, 1200 (precoding group: 602) remained for intention-to-treat, and 1131 (precoding group: 564) for per-protocol analysis. Precoding increased reimbursement per hospitalization day by 6.5% (160 US dollars; 95% confidence interval 31 to 289; P = 0.015). In a regression analysis patients hospitalized 7 days or longer, precoding increased reimbursement per day by 10.0% (246 US dollars; 95% confidence interval -12 to 504; P = 0.021). More secondary diagnoses (mean [SD]: 5.16 [5.60] vs 4.39 [5.34]; 0.77; 95% confidence interval 0.15 to 1.39; P = 0.015) and nonsurgical postoperative complications (mean [SD]: 0.68 [1.45] vs 0.45 [1.12]; 0.23; 95% confidence interval 0.08 to 0.38; P = 0.002) were documented by precoding. No associated was observed regarding the length of stay, total reimbursement, or case mix index. The mean (SD) precoding time effort was 37 (27) minutes per case.
Physician-led precoding increases DRG-based reimbursement. Precoding is time consuming and should be focused on cases with a longer hospital stay to increase efficiency.
在诊断相关分组 (DRG) 系统中，完整准确的诊断和手术记录对于医疗服务提供者的充分报销至关重要。本研究的目的是调查每日监测和半自动化的 DRG 编码（预编码）建议优化是否与住院日的更高报销相关。
这是一项平行组、非盲、随机临床试验，将患者以 1:1 的比例随机分配到干预组（预编码）和对照组。2019 年 6 月 12 日至 12 月 6 日，在瑞士一家医院的外科部门接受择期或急诊手术的所有住院患者（1566 例）均符合本研究条件。通过随机抽样选择，将病例分配到干预组（预编码）和对照组。主要结局是总报销除以住院天数。
在随机分配的 1205 例病例中，1200 例（预编码组：602 例）按意向治疗进行分析，1131 例（预编码组：564 例）按方案进行分析。预编码使住院日的报销增加了 6.5%（160 美元；95%置信区间 31 至 289；P=0.015）。在回归分析中，住院 7 天或以上的患者，预编码使每天的报销增加了 10.0%（246 美元；95%置信区间 -12 至 504；P=0.021）。预编码记录了更多的次要诊断（平均值[标准差]：5.16[5.60] vs 4.39[5.34]；0.77；95%置信区间 0.15 至 1.39；P=0.015）和非手术术后并发症（平均值[标准差]：0.68[1.45] vs 0.45[1.12]；0.23；95%置信区间 0.08 至 0.38；P=0.002）。预编码并未观察到住院时间、总报销或病例组合指数的相关变化。预编码的平均（标准差）时间投入为每个病例 37（27）分钟。
医生主导的预编码可增加基于 DRG 的报销。预编码耗时且应集中于住院时间较长的病例，以提高效率。
