Grouping of CHS&#x02014;DRG Complications and Comorbidities Based on Inductive Method and Experts Consulting Method&#x02014;&#x02014;Taking UPPP Surgery as an Example for DB33 and DB35 Enrollment

doi:10.19546/j.issn.1674-3830.2023.9.011

China Health Insurance ›› 2023, Vol. 0 ›› Issue (9) : 86-93. DOI: 10.19546/j.issn.1674-3830.2023.9.011

Grouping of CHS—DRG Complications and Comorbidities Based on Inductive Method and Experts Consulting Method——Taking UPPP Surgery as an Example for DB33 and DB35 Enrollment

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Abstract

Objective: The paper explores the optimal grouping method for UPPP surgery in the DB33 and DB35 groups. Methods: We take 55 patients enrolled in UPPP surgery during the one-year anniversary of CHS—DRG official payment at C hospital as an example. (1) Descriptive statistics were conducted on the average days of hospitalization and average cost per visit in the current group of UPPP surgery. (2) We summarized the diagnostic information of the comorbidities group (DB33) and the non-comorbidities group (DB35) based on induction method. (3) Expert consultation method was used to determine the impact of 79 diagnoses from the first page of medical record on medical resource consumption. (4) Based on the cost consumption characteristics of UPPP surgery, we regroup and compare the coefficient of variation (CV) and overall variance reduction coefficient (RIV) between the two groups. Results: (1) The average cost of UPPP surgery in the DB35 group was actually higher than that in the DB33 group. (2) Diagnosis that only requires the combination of other surgeries will increase the payment standard for DB35 group by more than 20% (greater than 3119.60 yuan). (3) We regrouped the disease based on the need to accompany other surgeries or procedures, and the RIV value of the new group increased from 0.02 to 0.58. Conclusion: The grouping strategy for comorbidities and complications should be adjusted appropriately based on the characteristics of the disease, and consideration should be given to grouping by combining surgeries or procedures in the surgical or operational disease group.

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UPPP / CHS—DRG / coefficient of variation / overall variance reduction coefficient

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Grouping of CHS—DRG Complications and Comorbidities Based on Inductive Method and Experts Consulting Method——Taking UPPP Surgery as an Example for DB33 and DB35 Enrollment[J]. China Health Insurance. 2023, 0(9): 86-93 https://doi.org/10.19546/j.issn.1674-3830.2023.9.011

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