[Severity of illness explains the inadequacy between diagnosis-related groups and intensive care patients. Groupe GHM].
OBJECTIVE
To assess the relationship between diagnosis related groups (DRG) and severity of illness in intensive care unit (ICU) patients in semf1tical and economical terms.


METHODS
Prospective, multicentric study including 13 medical and surgical ICUs for adults.


METHODS
Discharge reports of 3,215 ICU admissions including age, gender, diagnosis, organ system failures, length of stay (LOS) and severity of illness evaluated with severity scores (SS): simplified acute physiological score (SAPS). Apache II, Glasgow score and physiological score (PS).


METHODS
Semantical homogeneity was evaluated from the percentage of well-classified patients established from the comparison between the official computerized method and a non-computerized method applied by three clinical experts. Economical homogeneity was evaluated from the relationship between SS and LOS.


RESULTS
In total, 88% (CI: 87.7-88.2) of ICU stays were classified in eight main categories of diagnosis (MCD). According to the MCD, the percentage of well-classified patients varied from 28% (CI: 27.6-28.3) to 97% (CI: 96.8-97.1), decreasing with the association of several diagnoses and organ system failures. There was a large variability in the LOS of DRG and a significant correlation between LOS and SS was found in only 8/16 DRG.


CONCLUSIONS
The fact that the severity of illness is not taken into account in the elaboration of DRGs explains the inadequacy of the DRG system in intensive care.
Hermant
J L
JL
Département d'anesthésie-réanimation, hôpital Jean-Verdier, Université Paris XIII, Bondy.
Pourriat
J L
JL
Fosse
J P
JP
D000328:Adult; D000465:Algorithms; D003422:Critical Care / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008331:Management Information Systems; D011446:Prospective Studies; D012720:Severity of Illness Index