Weiland D E, Malone J M, Bay C, Garren R
Department of Surgery, Maricopa Medical Center, Phoenix, Arizona 85010, USA.
Am J Surg. 1995 Dec;170(6):651-4; discussion 654-5. doi: 10.1016/s0002-9610(99)80035-x.
A review of 1993 data on length of stay (LOS) and charges for diagnosis-related group (DRG) 195 (complicated cholecystectomies) showed that Maricopa Medical Center charged more and had longer LOS than all other area hospitals.
Twenty DRG 195 charts were analyzed for the causes of the inefficiencies. The remaining cholecystectomy DRGs were similarly analyzed.
Analysis of the charts for DRG 195 showed that 55% of the patients had laparoscopic conversions. Charges and LOS varied significantly because of the conversions, increased preoperative hospital days and increased operative times. Moreover, 30% of patients were more than 70 years old. Comparisons of other cholecystectomy DRGs showed similar inefficiencies, indicating a hospital system's problem.
Diagnosis-related group delta analysis is a powerful performance improvement tool. Once problem areas are identified and corrected, monitoring prospective data produces rapid analysis of quality of care and cost improvements. The models can serve as a means for teaching hospitals to become more competitive and satisfy the Joint Commission on Accreditation of Healthcare Organizations requirements for patient-care improvements.
对1993年有关诊断相关分组（DRG）195（复杂胆囊切除术）的住院时间（LOS）和费用的数据进行的回顾显示，马里科帕医疗中心比所有其他地区医院收费更高，住院时间更长。
对20份DRG 195病历进行分析，以找出效率低下的原因。对其余胆囊切除术DRG也进行了类似分析。
对DRG 195病历的分析表明，55%的患者进行了腹腔镜手术中转。由于手术中转、术前住院天数增加和手术时间延长，费用和住院时间有显著差异。此外，30%的患者年龄超过70岁。对其他胆囊切除术DRG的比较显示出类似的效率低下情况，表明这是医院系统的问题。
诊断相关分组差异分析是一种强大的绩效改进工具。一旦确定并纠正了问题领域，监测前瞻性数据就能快速分析医疗质量和成本改进情况。这些模型可作为教学医院提高竞争力和满足医疗组织评审联合委员会对改善患者护理要求的一种手段。
