[Medical information departments and medical program of information systems in psychiatry. Feasibility and consequences].
Like any country France needs to better control Health costs. The DRG (Diagnostic Related Groups) system designed in the USA by Fetter appears a solution and is progressively used in short term Medicine Surgery and Obstetric (MCO) units. Recently pilote sites started to collect data in the fields of psychiatry. First the DRG system in presented: 471 groups have been used in France in MCO though the completion of RSS (Standardized summarized discharge reports). Then details are given on the way this system functions in the USA: a national basic paiement ajusted according local norms (costs of salary, urban/rural districts, teaching status of the hospital, percentage of low social class status patients). The system is presented for psychiatry in the USA where psychiatry has been temporarily excluded because the 14 psychiatric DRG did not predicted costs: length of stay varies greatly for a DRG as "psychoses" or "neurotic depression". Various explanations have been proposed, along them ICD 9 classification has been accused of poor reliability beside many errors in the codification and large variability of procedures used for similar cases in psychiatry. Many factors have been studied in order to explain costs: the type of treatment setting (patients hospitalized in psychiatric units have longer duration than in general units) but none appears satisfactory. Specially two types of factors seem greatly to influence costs: targets of the treatment and outcome facilities. At any rate hospitalisation in short term units is only one of the setting where psychiatry is treated. Medium or long term hospitalisation and outpatient settings are used far more frequently. For those applications Fetter designed other approaches: RUG (Resource utilisation groups) for the long term and AVG (ambulatory visit groups) for ambulatory care. RUG is designed for aged persons: all nurses interventions are recorded and tabulated against indicators of pathology and disabilities; 9 groups could be constructed from simple indicators.(ABSTRACT TRUNCATED AT 250 WORDS)
Kovess
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DIM laboratoire associé Paris V, CHS La Verrière, MGEN, Le Mesnil-Saint-Denis.
Soyris
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D000553:Ambulatory Care / Q000191:economics; D003363:Cost Control / Q000639:trends; D003953:Diagnosis-Related Groups / Q000191:economics*; D005602:France; D006751:Hospital Information Systems / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016347:Medical Records Systems, Computerized / Q000191:economics*; D001523:Mental Disorders / Q000145:classification / Q000191:economics* / Q000628:therapy; D014481:United States
DIM et PMSI en psychiatrie. Faisabilité et enjeu.