title: Evaluation of the introduction of a diagnosis procedure combination system for patient outcome and hospitalisation charges for patients with hip fracture or lung cancer in Japan.
abstract: OBJECTIVE
  To evaluate the effects of introducing the Diagnosis Procedure Combination (DPC) system on outcomes, length of stay (LOS) and hospitalisation charges for patients with hip fractures or lung cancer. Patient outcome was evaluated by inpatient mortality, condition at discharge, and readmission within 42 days after discharge.
  
  
  METHODS
  DPC data were collected from 92 Japanese Red Cross Medical Centres and community hospitals between April 2005 and December 2008. Pre- and post-DPC outcomes were compared by multivariate regression with difference-in-difference analysis.
  
  
  RESULTS
  For hip fractures, the percentage of patients in worse condition at discharge was 150% higher when DPC was used [odds ratio (OR)=2.556, P<0.001]. For lung cancer, the percentage of patients in worse condition at discharge was about 30% lower when DPC was used (OR=0.697, P=0.001). The number of lung cancer diagnosis groups that did not require a long LOS increased. Inpatient mortality and readmission rates and hospitalisation charges did not change for either diagnosis, though the average LOS decreased.
  
  
  CONCLUSIONS
  Under the DPC system in Japan, some patients would be discharged 'quicker' and 'sicker', but other patients' outcome at discharge improved. Although LOS decreased, hospitalisation charges did not decrease, and the readmission rate did not increase.
authors.affiliation: Graduate School of Nursing, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku Tokyo 162-8666, Japan. kondo.akiko@twmu.ac.up
authors.forename: Akiko
authors.initials: A
authors.lastname: Kondo
authors.forename: Koichi
authors.initials: K
authors.lastname: Kawabuchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000191:economics*; D017722:Hospital Charges / Q000458:organization & administration*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008175:Lung Neoplasms / Q000191:economics*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012044:Regression Analysis; D012051:Reimbursement Mechanisms / Q000458:organization & administration*