BOOKS OF RtfiDIfGS - PAHO/WHO

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M i.]DICAL C(ARIF:
Fe,-n#arl lv0. VSm. VIIll No. 2, Supplement
PATIENTS treated in an acute-care facility
can Yvary considerably in both the duration
and intensity of services required to provicie
appr(>priate patient care. The relative
amounts and types of hospital outputs
utilized >y individttal patients are
depelident on both the condition oí the
patient and the treatnment process
employed. By relating the demographic,
diagilostic. aud therapeitic clharaiteristics
of patients to the hospital outputs they
utilize, a patient classification scheme can
be developed wvhich provides the
tramework for hoth the specification of
hospital case mix and the measurement of
the impact of case mix on hospital utilization
and performance. The Diagnosis-
Related Groups represent an attempt to
provide such a patient classification
scheme. As currently defined, the DRGs
provide a manageable number of patient
c;asses (383) that are exhaustive and minutually
exclusive with respect to the types of
patients seen in an acute-care setting.
Further, the DRGs provide patient classes
that are clinicially consistent and that have
similar patterns of output utilization as
measured by length of stay.
The comparison of patient data across
institutions or Droyviders will invariably reveal
the exi-t nC:e of differential levels of
utilizatior and performance. A comparative
analysis by average length of stay, cost,
or any other aggregate measure is not
meaningful unless the impact of different
case mix compositions can be determined.
The DRGs can provide a framework for
establishing the effects of case mix tas well
as for identifying diagnostic areas with potential
problems. The goal of most comparative
analyses is to isolate problem
areas s(; 4h.t corrective measure, ann be
initiated. If prograims aimed ait itiaproviuig
the performance ofthe hospital health-care
system are to be successful, managers and
7. Summary and Conclusions
regulators must establish an effective
dialogue with those responsible for the delivery
of services, the physician comimunity.
The DRGs provide the first step in suclh
a dialogue since problems defined in the
contextof DRGs are understandable fronm a
clinical perspective.
The various actual and potential applications
ofthe DRGs in the areas of utilization
review, hospital bucdgeting and cost coatrol,
prospective reimbursement and regional
planning emphasize the central role
of the patient. By focusing on the types of
patients being treated, programs responsihle
for these activities will share a common
conceptual basis even though they are
concerned with different aspects of the
health care system. While the applications
to date llave been implemented to meet the
immediate needs of the individual programs,
future work will be directed toward
exploring the potential of the DRGs in
achieving better integration and.coordination
of the different program goals and.
activities.
The current set of 383 DRGs were developed
in light ofthe available data and its
limitations at the time of their construction.
As such, they representjust one imple mentation
of an evolving series of patient
classification schemes. As more comprehensive
and reliable patient data become
available and the practice of medicine
changes, the DRGs must adapt to reflect
these changes. To this end, it is felt that the
technology and strategy used in forming
the DRGs can be applied in the developnment
of future generations of classification
systems. Indeed, a major revision and
evaluation ofthe DRGs will be undertaken
as soon as ICD-9-CM data are available in
sníflicient quantities. Further, work has
begun in extending the approach into otlier
areas of health-care delivery, in particular,
ambulatory care.2'
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