A review of the complexity adjustment in the Korean Diagnosis-Related Group (KDRG)
DC Field | Value | Language |
---|---|---|
dc.contributor.author | Kim, S. | - |
dc.contributor.author | Jung, C. | - |
dc.contributor.author | Yon, J. | - |
dc.contributor.author | Park, H. | - |
dc.contributor.author | Yang, H. | - |
dc.contributor.author | Kang, H. | - |
dc.contributor.author | Oh, D. | - |
dc.contributor.author | Kwon, K. | - |
dc.contributor.author | Kim, S. | - |
dc.date.available | 2019-03-08T06:56:14Z | - |
dc.date.issued | 2020-01 | - |
dc.identifier.issn | 1833-3583 | - |
dc.identifier.issn | 1833-3575 | - |
dc.identifier.uri | https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/3236 | - |
dc.description.abstract | Background: The Korean Diagnosis-Related Groups (KDRG) was revised in 2003, modifying the complexity adjustment mechanism of the Australian Refined Diagnosis-Related Groups (AR-DRGs). In 2014, the Complication and Comorbidity Level (CCL) of the existing AR-DRG system was found to have very little correlation with cost. Objective: Based on the Australian experience, the CCL for KDRG version 3.4 was reviewed. Method: Inpatient claim data for 2011 were used in this study. About 5,731,551 episodes, which had one or no complication and comorbidity (CC) and met the inclusion criteria, were selected. The differences of average hospital charges by the CCL were analysed in each Adjacent Diagnosis-Related Group (ADRG) using analysis of variance followed by Duncan’s test. The patterns of differences were presented with R2 in three patterns: The CCL reflected the complexity well (VALID); the average charge of CCL 2, 3, 4 was greater than CCL 0 (PARTIALLY VALID); the CCL did not reflect the complexity (NOT VALID). Results: A total of 114 (19.03%), 190 (31.72%) and 295 (49.25%) ADRGs were included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average R2 for hospital charge of CCL was 4.94%. The average R2 in VALID, PARTIALLY VALID and NOT VALID was 4.54%, 5.21%, and 4.93%, respectively. Conclusion: The CCL, the first step of complexity adjustment using secondary diagnoses, exhibited low performance. If highly accurate coding data and cost data become available, the performance of secondary diagnosis as a variable to reflect the case complexity should be re-evaluated. Implications: Lack of reviewing the complexity adjustment mechanism of the KDRG since 2003 has resulted in outdated CC lists and levels that no longer reflect the current Korean healthcare system. Reliable cost data (vs. charge) and accurate coding are essential for accuracy of reimbursement. © The Author(s) 2018. | - |
dc.format.extent | 7 | - |
dc.language | 영어 | - |
dc.language.iso | ENG | - |
dc.publisher | SAGE Publications Inc. | - |
dc.title | A review of the complexity adjustment in the Korean Diagnosis-Related Group (KDRG) | - |
dc.type | Article | - |
dc.identifier.doi | 10.1177/1833358318795804 | - |
dc.identifier.bibliographicCitation | Health Information Management Journal, v.49, no.1(SI), pp 62 - 68 | - |
dc.description.isOpenAccess | N | - |
dc.identifier.wosid | 000503522700008 | - |
dc.identifier.scopusid | 2-s2.0-85053432436 | - |
dc.citation.endPage | 68 | - |
dc.citation.number | 1(SI) | - |
dc.citation.startPage | 62 | - |
dc.citation.title | Health Information Management Journal | - |
dc.citation.volume | 49 | - |
dc.type.docType | Article in Press | - |
dc.publisher.location | 호주 | - |
dc.subject.keywordAuthor | case complexity | - |
dc.subject.keywordAuthor | casemix | - |
dc.subject.keywordAuthor | casemix | - |
dc.subject.keywordAuthor | classification | - |
dc.subject.keywordAuthor | clinical coding | - |
dc.subject.keywordAuthor | data quality | - |
dc.subject.keywordAuthor | Diagnosis-related groups | - |
dc.subject.keywordAuthor | Diagnosis-related groups | - |
dc.subject.keywordAuthor | ICD-10 | - |
dc.subject.keywordAuthor | prospective payment system | - |
dc.relation.journalResearchArea | Health Care Sciences & Services | - |
dc.relation.journalResearchArea | Medical Informatics | - |
dc.relation.journalWebOfScienceCategory | Health Policy & Services | - |
dc.relation.journalWebOfScienceCategory | Medical Informatics | - |
dc.description.journalRegisteredClass | scie | - |
dc.description.journalRegisteredClass | ssci | - |
dc.description.journalRegisteredClass | scopus | - |
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.
84, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea (06974)02-820-6194
COPYRIGHT 2019 Chung-Ang University All Rights Reserved.
Certain data included herein are derived from the © Web of Science of Clarivate Analytics. All rights reserved.
You may not copy or re-distribute this material in whole or in part without the prior written consent of Clarivate Analytics.