Z I M - Artikel in: SMI Nr. 63 – 2008 März 2008

Von APDRG-CH zu G-DRG/SwissDRG

Wolfram Fischer

Zentrum für Informatik und wirtschaftliche Medizin
CH-9116 Wolfertswil SG (Schweiz)
http://www.fischer-zim.ch/

Ein Blick auf das «familiäre Umfeld» und auf einige Unterschiede

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Inhaltsverzeichnis

1 Einleitung

2 Was charakterisiert Patientenklassifikationssysteme der DRG-Familie?

3 Was bringt die Ahnentafel ans Licht?

4 Womit profilierten sich die alternativen Mitglieder der DRG-Grossfamilie?

5 Rivalenkämpfe: Wessen DRGs sind am homogensten?

6 Herausforderungen auf dem Weg zur Reife

7 Entwicklungsschritte am Beispiel von AP-DRG zu G-DRG (bzw. SwissDRG)

8 Ausblick auf die schweizerische DRG-Zukunft

9 ANHANG

Abstract

INTRODUCTION

The AP-DRG system has been in use in a number of the Swiss cantons for some years now. Until 2012, a prospective payment system for acute hospitals has to be introduced at Federal level. The DRG system used for this purpose will be named «SwissDRG». It will be based on the german G-DRG system.

1

DRG DEVELOPMENT

The first part of the paper highlights some background aspects of the DRG development. Since the HCFA-DRG system was used for the first time for in 1983, the DRG idea spread around the world and led to new DRG systems especially in USA, Europe and Australia.

2

Variance Reduction

Two of the most challenging trend words thrown up by this competition were the «refinement» of the systems and the achieved «variance reduction» (VR). The ‹leader› in terms of VR is at the moment the G-DRG system. However, it seems that this statistical optimisation was achieved at the expense of clinical comprehensibility.

3

Refinement

Several DRG systems are called «refined» systems, but there is no consensus about what this term stands for. Depending on the system, it can mean: that more than two severity levels («CC levels») are used; that base DRGs are named; that not only one but several lists of ‹complications and comorbidities› (CCs) are used; that the CC level is derived from more than only one secondary diagnosis.

4

Repeated partial redesign

Some domains appear to be difficult to model and have therefore been redesigned more than once, e. g. neonates, paediatric DRGs, intensive care, multiple treatments.

5

From AP-DRG
to G-DRG/SwissDRG

The second part of the paper focuses on the change from the AP-DRG system to the G-DRG system (which is the starting point for the SwissDRG system). This will cause different challenges to Swiss AP-DRG users. The G-DRG system is more differentiated (hence, it will be welcomed by university and central hospitals) and its statistical performance is better. However, it is also more complex. For the moment the G-DRG is undergoing very dynamic development; the changes from one year to the next are rather big. It must be hoped that there will be some effort to regain a good comprehensibility until the introduction of G-DRGs as SwissDRGs.

6

Z I M - Zentrum für Informatik und wirtschaftliche Medizin
CH-9116 Wolfertswil (SG), Steigstrasse 12, Schweiz
E-Post: , Tel: +41 71 3900 444

Vorheriger Artikel: Inhaltsverzeichnisse: Nächster Artikel:
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Z I M - Hauptseite


1	Einleitung
2	Was charakterisiert Patientenklassifikationssysteme der DRG-Familie?
3	Was bringt die Ahnentafel ans Licht?
4	Womit profilierten sich die alternativen Mitglieder der DRG-Grossfamilie?
5	Rivalenkämpfe: Wessen DRGs sind am homogensten?
6	Herausforderungen auf dem Weg zur Reife
7	Entwicklungsschritte am Beispiel von AP-DRG zu G-DRG (bzw. SwissDRG)
8	Ausblick auf die schweizerische DRG-Zukunft
9	ANHANG

INTRODUCTION	The AP-DRG system has been in use in a number of the Swiss cantons for some years now. Until 2012, a prospective payment system for acute hospitals has to be introduced at Federal level. The DRG system used for this purpose will be named «SwissDRG». It will be based on the german G-DRG system.	1
DRG DEVELOPMENT	The first part of the paper highlights some background aspects of the DRG development. Since the HCFA-DRG system was used for the first time for in 1983, the DRG idea spread around the world and led to new DRG systems especially in USA, Europe and Australia.	2
Variance Reduction	Two of the most challenging trend words thrown up by this competition were the «refinement» of the systems and the achieved «variance reduction» (VR). The ‹leader› in terms of VR is at the moment the G-DRG system. However, it seems that this statistical optimisation was achieved at the expense of clinical comprehensibility.	3
Refinement	Several DRG systems are called «refined» systems, but there is no consensus about what this term stands for. Depending on the system, it can mean: that more than two severity levels («CC levels») are used; that base DRGs are named; that not only one but several lists of ‹complications and comorbidities› (CCs) are used; that the CC level is derived from more than only one secondary diagnosis.	4
Repeated partial redesign	Some domains appear to be difficult to model and have therefore been redesigned more than once, e. g. neonates, paediatric DRGs, intensive care, multiple treatments.	5
From AP-DRG to G-DRG/SwissDRG	The second part of the paper focuses on the change from the AP-DRG system to the G-DRG system (which is the starting point for the SwissDRG system). This will cause different challenges to Swiss AP-DRG users. The G-DRG system is more differentiated (hence, it will be welcomed by university and central hospitals) and its statistical performance is better. However, it is also more complex. For the moment the G-DRG is undergoing very dynamic development; the changes from one year to the next are rather big. It must be hoped that there will be some effort to regain a good comprehensibility until the introduction of G-DRGs as SwissDRGs.	6

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