Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

KCE Reports 94 Maternal Intensive Care in Belgium 35
Pourcentage
80
70
60
50
40
30
20
10
19 see appendix
0
The level of severity of illness - classification within the APR-DRG is a complex matrix,
which was designed to calculate the hospital workload and the therefore required
finance. These levels of severity are based mainly on secondary diagnoses.
The relation between the level of severity and the seriousness of the pathology is not
straightforward. Each woman has only one main diagnosis, but women can have more
than one second diagnosis
The MKG/RCM database unfortunately provides no longitudinal follow-up. Moreover,
for privacy reasons, exact dates are unknown. Only number of week, month and year
are available.
The MKG/RCM database contains a wide array of variables pertaining to the diagnostic
and therapeutic aspects of the admission as well as a number of patient characteristics;
information on the successive bed types and services during the stay. There is a specific
database for newborns. 19
It is important to note that this MKG/RCM database is used primarily to measure
hospital case-mix for financing, not epidemiological purposes. Thus reporting bias can
not be ruled out.The level of severity is determined by the coded secondary diagnoses.
It is highly unlikely that from 1997 to 2004, the actual morbidity has increased. The
increase of the coded level of severity is a well-described and well-known phenomenon,
it implies that patients are placed in higher level of severity yielding a higher standard
price than justified by their actual health status (Bjørnenak et al., 2000)(Hsia et al.,
1988)(Colin Preyra, 2004) 20 . In this context, it is very interesting to see the Belgian
evolution of the severity in the APR-DRG along the years.
Figure 2: Evolution of the degree of severity 1
Proportion of stays with APR-DRG in degree of severity 1
1997 2000 2001
Years
2002 2003 2004
Source: Feedback Cellule technique - https://tct.fgov.be/etct/anonymous?lang=fr
Figure 3 shows the evolution of the APR-DRG 560: ‘Vaginal delivery’. In 1997, 75.3 % of
the in-patient stays were attributed a degree of severity I. In 2004, the proportion of
stays in degree of severity I was only 58.1%. The same evolution is noticed for ‘APR-
DRG 540: ‘Caesarean delivery’. The proportion of in-patient stays with a degree of
severity 1 was 62.4% in 1997 and only 46.4% in 2004. It is rather unlikely that from 1997
to 2004 morbidity has actually increased to such an extent. Rather, it may be suspected
that increasing proportions of women with a higher degree of severity of morbidity are
an artefact related to the financial rewarding of higher levels of severity.
APR-DRG 540 c-section
APR-DRG 560 vag delivery