Phelan P D, Baxter K, Bishop J, Hudson I, Hindle D
Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
J Paediatr Child Health. 1993 Aug;29(4):266-9. doi: 10.1111/j.1440-1754.1993.tb00509.x.
The ability of diagnosis related groups (DRG) and refinement diagnosis related groups (RDRG) to measure differences in case-mix was investigated using discharge data for patients < 18 years of age from three specialist children's hospitals and four district hospitals. While the three children's hospitals each had a greater percentage of RDRG for more complex patients, only one children's hospital had more complex patients based on DRG and RDRG cost weights and on the percentage of diagnoses per discharge. Cost weights based on USA practices may be inappropriate in Australia, and Australian weights will be necessary for firm conclusions. Refinement diagnosis related groups with appropriate cost weights may be acceptable measures of case-mix in specialist children's hospitals, but they have inherent limitations for paediatric patients in that many complex paediatric patients are ill very seriously with one disorder, whereas complex adult patients usually have secondary diagnoses and secondary procedures. Moreover, no DRG version developed in the US will be suitable for use in Australia unless it takes account of medical costs and transfer practice.
利用来自三家儿童专科医院和四家地区医院的18岁以下患者的出院数据，研究了诊断相关组（DRG）和细化诊断相关组（RDRG）衡量病例组合差异的能力。虽然三家儿童医院中，每家针对病情更复杂患者的RDRG比例都更高，但基于DRG和RDRG成本权重以及每次出院诊断百分比来看，只有一家儿童医院有病情更复杂的患者。基于美国做法的成本权重在澳大利亚可能并不适用，要得出确凿结论需要澳大利亚的权重。具有适当成本权重的细化诊断相关组可能是儿童专科医院病例组合的可接受衡量指标，但它们对儿科患者存在固有局限性，因为许多复杂儿科患者患有一种疾病时病情非常严重，而复杂成年患者通常有二次诊断和二次手术。此外，美国开发的任何DRG版本都不适用于澳大利亚，除非它考虑到医疗成本和转诊情况。
