Classification scheme consisting of groups of

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classification scheme consisting of groups of patients who were similar, both clinically, and in terms of their consumption of hospital resources. During the process of developing the DRG patient classification scheme, several alternative approaches to constructing the patient groups were investigated. Initially, a normative approach was used which involved having clinicians define the DRGs using the patient characteristics they felt were important for determining resource intensity. There was a tendency for these definitions to include an extensive set of specifications requiring information which might not always be col- lected through a hospital’s medical information system. If the entire range of patients were classified in this manner, there would ultimately be thousands of DRGs, most of which described
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5 patients seen infrequently in a typical hospital. It therefore became evident that the process of DRG definition would be facilitated if data from acute care hospitals could be examined to deter- mine the general characteristics and relative frequency of different patient types. In addition, statistical algorithms applied to this data would be useful to suggest ways of forming DRGs that were similar in terms of resource intensity. However, it was also discovered that statistical algo- rithms applied to historical data in the absence of clinical input would not yield a satisfactory set of DRGs. The DRGs resulting from such a statistical approach, while similar in terms of resource intensity, would often contain patients with a diverse set of characteristics which could not be interpreted from a clinical perspective. Thus, it became apparent that the development of the DRG patient classification scheme required that physician judgment, statistical analysis and verifi- cation with historical data be merged into a single process. It was necessary to be able to examine large amounts of historical data with statistical algorithms available for suggesting alter- native ways of forming DRGs but to do so in such a way that physicians could review the results at each step to insure that the DRGs formed were clinically coherent. Basic characteristics of the DRG patient classification system Given the limitations of previous patient classification systems and the experience of attempting to develop DRGs with physician panels and statistical analysis, it was concluded that in order for the DRG patient classification system to be practical and meaningful, it should have the following characteristics: The patient characteristics used in the definition of the DRGs should be limited to information routinely collected on hospital abstract systems. There should be a manageable number of DRGs which encompass all patients seen on an inpatient basis.
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  • Fall '18
  • Diagnosis-related group, DRGs

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