Distribution of critically ill patients (CIP) with severe sepsis (SS) according to the major diagnostic categories (MDC) of the diagnosis-related groups (DRG)

  • J Ruiz Moreno
  • E González Marín
  • MJ Esteve Paños
  • M Juliá Amill
  • N Suárez Álvarez
  • M Moral Guiteras
  • F Baigorri González
  • A Artigas Raventós
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Keywords

Public Health Alcohol Severe Sepsis Competitive Advantage Relative Weight 

Introduction

Apart from financial purposes (cost accounting), DRG as case - mix system are not used for obtaining competitive advantage. MDC can be useful to classify the SS; if so, it is possible to assign each focus of sepsis to a specific category, which is important from a socio-economic perspective.

Objectives

  • Identify which MDCs encompasses a greater or lesser number of CIPs con SS.

  • Find out which MDC incorporating CIPs with SS carries a higher an average relative weight (RW).

Methods

  • Type of Study: prospective, analytical, longitudinal, and observational

  • Period: January 1-2011 / June 30-2014 (42 months)

SETTING

Medical/Surgical ICU

  • Population: 2559 CIPs admitted consecutively to the ICU; sample: 484 CIPs.

  • Exclusión criteria: CIPs < 16 y., major burn CIPs, incomplete clinical documentation, and voluntary discharge.

  • DRG AP-DRG 25.0 version (684 DRG are grouped into 25 MDC and 1 extra MDC).

  • Depending on the focus of sepsis, SS related to MDC '0' (precategoría) are transferred to another MDC.

  • MDC: 1 (neurology), 2 (eye), 3 (ear, nose, mouth, throat), 4 (respiratory), 5 (circulatory), 6 (digestive, 7 (hepatobiliary & pancreas), 8 (musculoskeletal & connective), 9 (skin & breast), 10 (endocrine), 11 (urinary tract), 12 (male reproductive), 13 (female reproductive), 14 (pregnancy & childbirth), 15 (newborn), 16: (blood & immunological), 17 (mMyeloproliferative), 18 (infectious), 19 (mental), 20 (alcohol / drug), 21 (Injuries & poison), 22 (burns), 23 (factors influencing health status), 24 (HIV), 25 (PLT), 0 (PreMed, miscellany)

Results

See Tables 1, 2 and 3.
Table 1

Results I

 

Global

%

SS

%

no SS

%

p value

CIPs

2559

100

484

18,8

2075

81,1

 

Age

65,9

 

73,5

 

64,1

 

0,001

Mortality

159

6,21

119

24,6

63

3,0

0,001

RW

4,21

 

7,9

 

3,35

 

0,001

Table 2

Results II.

MDC

SS

%

average RW

1

8

1,7

8,4598

4

114

24,0

11,0677

5

30

6,3

6,1961

6

152

32,0

9,9382

7

94

19,8

4,5068

Table 3

Results III.

MDC

SS

%

average RW

8

14

2,9

5,1191

9

8

1,7

4,0320

11

22

4,6

5,1687

18

33

6,9

3,7598

Global

475

100

7,9815

Excluded MDCs (< 8 DRG with SS): '2', '3', '4', '12','13', '14', '15', '16', '17', '19', '20', '21', '22', '23', '24' y '25'

Conclusions

  • 16 MDC do not identify SS (or less than 8 DRG).

  • MDC '6', '4' and '7' carry more SS, that, it respectively, correspond to the septic focus abdominal, respiratory, and biliopancreatic.

  • MDC '4' and '6' show the highest RW

References

  1. 1.
    Busse r, Geissler A, Quentin W, Wiley M: Diagnosis-Related Groups in Europe. Moving towards transparency, efficiency and quality in hospitals Open Univy Press. 2011, McGraw-Hill Education, England, European Observatory onHealth Systems and PoliciesGoogle Scholar
  2. 2.
    Homburg K, Rüst CA, Fodor P, Blumenthal S: Do Diagnosis Related Groups change admission practice to a large Swiss ICU?. Critical Care. 2013, 17 (Suppl 2): 484-Google Scholar

Copyright information

© Ruiz Moreno et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • J Ruiz Moreno
    • 1
  • E González Marín
    • 1
  • MJ Esteve Paños
    • 1
  • M Juliá Amill
    • 1
  • N Suárez Álvarez
    • 1
  • M Moral Guiteras
    • 1
  • F Baigorri González
    • 1
  • A Artigas Raventós
    • 2
  1. 1.QuirónSalud Hospital Universitario Sagrat CorCritical Care DepartmentBarcelonaSpain
  2. 2.Hospital de Sabadell & QuirónSalud Hospital Universitario Sagrat CorCritical Care DepartmentSabadellSpain

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