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Main Title: Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries
Author(s): Peltola, Mikko
Quentin, Wilm
Type: Article
Language Code: en
Abstract: Background: Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. Methods: National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. Results: European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries’ systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. Conclusions: Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and national DRG authorities should consider how other countries’ DRG systems classify stroke patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement. In future, quantitative research is needed to verify whether the most important determinants of cost are considered in different patient classification systems, and whether differences between systems reflect country-specific differences in treatment patterns and, most importantly, what influence they have on patient outcomes.
Issue Date: 2013
Date Available: 26-Oct-2017
DDC Class: 610 Medizin, Gesundheit
Subject(s): acute stroke
diagnosis-related groups
hospital financing
cerebral infarct
Sponsor/Funder: EC/FP7/233683/EU/Safe Road Trains for the Environment; developing strategies and technologies to allow vehicle platoons to operate on normal public highways with significant environmental, safety and comfort benefits/SARTRE
Usage rights: Terms of German Copyright Law
Journal Title: Cerebrovascular Diseases
Publisher: Karger
Publisher Place: Basel, München
Volume: 35
Issue: 2
Publisher DOI: 10.1159/000346092
Page Start: 113
Page End: 123
EISSN: 1421-9786
ISSN: 1015-9770
Notes: Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.
Appears in Collections:Fachgebiet Management im Gesundheitswesen » Publications

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