Describing Serbian Hospital Activity Using Australian Refined Diagnosis Related Groups: A Case Study in Vojvodina Province

Zdr Varst. 2019 Dec 13;59(1):18-26. doi: 10.2478/sjph-2020-0003. eCollection 2020 Mar.

Abstract
in English, Slovenian

Introduction: AR-DRG system for classification hospital episodes was implemented in Serbia to improve efficiency and transparency in the health system.

Methods: L3H3, IQR, and 10th-95th percentile methods were used to identify outlier episodes in the classification. Classification efficiency and within-group homogeneity were measured by an adjusted reduction in variance (R2) and a coefficient of variation (CV).

Results: There were 246,131 hospital episodes with a total 1,651,913 bed days from 14 hospitals. All episodes were classified into 652 groups of which 441 had CV lower than 100%. "Medical groups" accounted for 51% of groups and for 72% of episodes. Chemotherapy and vaginal delivery were the highest volume groups, with 5% and 4% of total episodes. Major diagnostic category 6 (MDC 6, Diseases of the digestive system) was the highest volume MDC, accounting for 11% of episodes. "Day-cases" and "prolonged hospitalisation" accounted for 21% and 3% of episodes, respectively. The average length of stay varied from 5.6 to 8.2 days. Adjusted R2 was 0.3 for untrimmed data. Trimming by L3H3, IQR, and 10th-95th percentile method improved the value of adjusted R2 to 0.61, 0.49, and 0.51, identifying 24%, 7%, and 7% of total cases as outliers, respectively. Mental diseases (MDC 19) remained the lowest adjusted R2 in untrimmed and trimmed datasets.

Conclusion: A long length of stay and a small percentage of "day-cases" characterized hospital activity in Vojvodina. Trimming methods significantly improved DRG efficiency. Future studies should consider cost data.

Uvod: Klasifikacijski sistem hospitalizacij AR-DRG je bil v Srbiji vpeljan za izboljšanje učinkovitosti in preglednosti zdravstvenega sistema.

Metode: Za prepoznavanje odstopanj v klasifikaciji so bile uporabljene metode L3H3, IQR, in 10.-95. percentila. Učinkovitost klasifikacije in homogenosti znotraj skupine primerljivih primerov diagnoz sta bili izmerjeni s prilagojenim zmanjšanjem neskladij (R2) in koeficientom razlik (CV).

Rezultati: Zabeleženih je bilo 246.131 hospitalizacij s skupnim številom 1.651.913 preležanih dni v 14 bolnišnicah. Vse hospitalizacije so bile razvrščene v 652 skupin, od tega jih je imelo 441 vrednost CV nižjo od 100 %. »Kliničnih skupin« je bilo 51 % od vseh skupin in 72 % od vseh hospitalizacij. Kemoterapija in vaginalni porod sta po obsegu največji skupini s 5 % in 4 % vseh hospitalizacij. Skupina primerljivih primerov diagnoz 6 (MDC 6, bolezni prebavnega sistema) je največja, in sicer zavzema 11 % vseh hospitalizacij. »Dnevne obravnave« obsegajo 22 % in »podaljšane hospitalizacije« 3 % hospitalizacij. Povprečno trajanje hospitalizacije se giblje med 5,6 in 8,2 dni. Prilagojeni R2 se obravnava za 0,3 neprirezanih podatkov. Aplikacija metod L3H3, IQR, in 10.-95. percentila je izboljšala vrednost prilagojenega R2 na 0,61, 0,49 in 0,51, esktremne vrednosti so se pojavljale v 24 %, 7 % in 7 % vseh primerov. Duševne bolezni (MDC 19) imajo najnižji prilagojen R2 v neprirezanih in prirezanih podatkovnih setih.

Zaključek: Bolnišnično dejavnost v Vojvodini označuje dolgotrajna hospitalizacija in nizek delež dnevnih obravnav. Metode prirezovanja so opazno izboljšale učinkovitost DRG. Prihodnje raziskave naj vključijo še stroškovni vidik.

Keywords: AR-DRG; average length of stay; casemix; clinical coding; healthcare financing; outliers; reduction of variance.