Abstract:
Do You Speak DRG ?

Abstract (English)

Patient Classification Systems are constructed by collapsing similar diagnoses and/or treatments into not too many discrete groups, typically about 500 to 1000. These patient categories are usable if their labels are comprehensible.

In this study, the complexity of the DRG labels of several DRG systems is explored over time.

DRG systems used in the USA (Medicare DRG 1994 until 2008), in Australia (AN-DRG 3.1, AR-DRG 4.1, AR-DRG 5.2), and in Germany (G-DRG 2003 until 2008) were inspected. As data, only the DRG labels had to be looked at.

For each DRG label, the following conjunctions were counted: "and", "or", "with", "without", "except"; commas, slashes, pairs of brackets and the word "age". Sequenced conjunctions are counted as 1.

Whereas the number of conjunctions used in labels of Medicare DRGs stays relatively unchanged over time (the quota of labels with four or more conjunctions increases from 9 % to 11 %), there is some change within the labels from AN-DRG 3.1 through AR-DRG 4.1 to AR-DRG 5.2 (11 / 15 / 13 %). In contrast, there is a great increase in the use of conjunctions in the G-DRG labels (17 % to 49 %).

The use of conjunctions does not only impair the comprehensibility of DRG labels but sometimes makes expressions ambiguous or practically unintellegible.

To get better DRG labels, it could be of help to use logical brackets, to split up complex DRGs for clinical homogeneity, or to construct patient classification systems for use in "cushioned" remuneration systems.

A DRG system should not only be useful for statisticians, but it should also serve as a basis for discussions between clinicians and managers. Thus it is necessary to make sure that DRG labels are compehensible. This is especially important when DRG systems are strongly optimised with regard to statistical performance (as was done with the G-DRG system).