Giuliano G, Catalano S, Baldacci S, Capuani A, Donato L
U.O. di Tecnica e Organizzazione Ospedaliera, Reparto di Epidemiologia e Biostatistica, Azienda Creas-IFC-CNR, Pisa.
G Ital Cardiol. 1996 Oct;26(10):1157-74.
The evaluation of Health Care activities, particularly of those concerning hospitals, is one of the most important aims for the National Health Service for a "fair" resource allocation. In the recent past a great bulk of research has been directed to methods for patient classifications in relation to resource needs. Diagnosis Related Groups (DRG) is one of the most important patient classification systems related to resource allocation which has been developed in the U.S. Medicare Program (HCFA-DRGs) during the eighties and more recently adopted all over Europe, Italy included. Wide experimentation has been developed during the recent past concerning DRGs confirming its validity, but also has disclosed its limits, mostly concerning applicability outside U.S., identification of specific patient subgroups (like the pediatric patient population) and capability in distinguishing patients with apparently similar resource needs, but different clinical severity conditions. In order to overcome such limits, DRGs have been subjected to some important modification: All patient DRG (AP-DRG) is a system which should pay more attention to some patient subgroups, such as the pediatric one. Research is still looking for methods, easily extensible to the whole hospital informative system concerning the possibility of distinguishing patients with different level of severity condition. With the double aim of experiment the actual utility in the use of AP-DRG, more than HCFA-DRG in a pediatric population and find further indexes for complexity and/or severity characterization of the hospital case-mix, the 1992 in-patients hospital files of the pediatric cardiosurgery hospital CREAS-IFC-CNR was reviewed. Results confirm that some increase in the identification of the case-mix do occur by using the AP-DRG system, even if a better clinical characterization could be possible (i.e. AP-DRG 108). Of particular interest is the fact that descriptive statistical analysis of position and variability parameters do confirm the importance of the length of stay as a brief index for hospital efficiency evaluation and its organizative model characterization.
对医疗保健活动，尤其是与医院相关的活动进行评估，是国家医疗服务体系实现“公平”资源分配的最重要目标之一。在最近，大量研究都集中在与资源需求相关的患者分类方法上。诊断相关分组（DRG）是与资源分配相关的最重要的患者分类系统之一，它是20世纪80年代在美国医疗保险计划（HCFA - DRG）中开发的，最近在包括意大利在内的整个欧洲都得到了采用。在最近，针对DRG进行了广泛的试验，证实了其有效性，但也揭示了其局限性，主要涉及在美国境外的适用性、特定患者亚组（如儿科患者群体）的识别以及区分资源需求看似相似但临床严重程度不同的患者的能力。为了克服这些局限性，DRG进行了一些重要的修改：所有患者DRG（AP - DRG）是一个应更加关注某些患者亚组（如儿科亚组）的系统。研究仍在寻找易于扩展到整个医院信息系统的方法，以区分不同严重程度的患者。为了实现双重目标，即试验AP - DRG在儿科人群中的实际效用（比HCFA - DRG更有用），并找到医院病例组合复杂性和/或严重程度特征的进一步指标，对儿科心脏外科医院CREAS - IFC - CNR 1992年的住院患者病历进行了审查。结果证实，使用AP - DRG系统确实在一定程度上增加了病例组合的识别，即使可能有更好的临床特征描述（即AP - DRG 108）。特别值得关注的是，位置和变异性参数的描述性统计分析确实证实了住院时间作为医院效率评估及其组织模式特征的简要指标的重要性。
