title: Diagnosis-related group refinement with diagnosis- and procedure-specific comorbidities and complications.
abstract: Diagnosis-related groups have been revised through more refined uses of secondary diagnoses. Under the refined diagnosis-related groups, patients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a different level of utilization for a given principal diagnosis or surgical procedure. The refined system was evaluated with national data from the Medicare program. Estimates of hospital costs and utilization based on refined diagnosis-related groups were more precise than those based on unrefined diagnosis-related groups. This approach to diagnosis-related group refinement does not represent a radical departure from the current diagnosis-related group framework and does not require new data collection efforts. Moreover, a payment system based on the refined model is less affected by the ordering of the diagnoses than under the existing diagnosis-related group system. How the refined diagnosis-related group framework can accommodate future refinements at all levels of the classification scheme is also discussed.
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, Galveston 77555-0460, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Freeman
authors.forename: R B
authors.initials: RB
authors.lastname: Fetter
authors.forename: H
authors.initials: H
authors.lastname: Park
authors.forename: K C
authors.initials: KC
authors.lastname: Schneider
authors.forename: J L
authors.initials: JL
authors.lastname: Lichtenstein
authors.forename: J S
authors.initials: JS
authors.lastname: Hughes
authors.forename: W A
authors.initials: WA
authors.lastname: Bauman
authors.forename: C C
authors.initials: CC
authors.lastname: Duncan
authors.forename: D H
authors.initials: DH
authors.lastname: Freeman
authors.forename: G R
authors.initials: GR
authors.lastname: Palmer
mesh_terms: D000328:Adult; D015897:Comorbidity; D003953:Diagnosis-Related Groups / Q000145:classification* / Q000191:economics / Q000639:trends; D005260:Female; D006753:Hospital Records; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D015233:Models, Statistical; D011445:Prospective Payment System; D012720:Severity of Illness Index; D012737:Sex Factors; D014481:United States