PubMed · 9796181
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W L Adams. 1998. Coding concepts.. https://pubmed.ncbi.nlm.nih.gov/9796181/
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OBJECTIVE: In a context of organization of care where the budget of hospitals is a function of the number and of the severity of the in-patients and not of the duration of stay, stays of long duration (SLD) in short-stay hospitals represent a problem of both medical and administrative management. To identify the characteristics of long-duration stays. METHODS: The data used in this retrospective study were drawn from the Standardized Discharge Summaries of the year 1997 of a University Hospital of the Paris area (France). A stay of long duration (SLD) was defined in an arbitrary way as a stay exceeding 30 days. The stays of long duration (> 30 days) were subdivided in "long stays" (from 31 to 60 days) and "very long stays" (more than 60 days). RESULTS: The SLDs represent 3.7% of the discharge summaries of our hospital, among them, 40% are medical DRGs and 60% surgical DRGs. The patients in SLD more often come from other structures of care than the patients having a short duration stay of (SDS) coming mainly from their residence and were also hospitalised in several different units during their stay. Patients having a long stay were more often classified in DRGs outside the principal activity of this hospital (i.e. cardiovascular diseases). CONCLUSION: This first approach suggests that a set of simple descriptive variables (pre-existing and acquired co-morbidity, admission in surgical ward, multi-unit stay...) makes it possible to identify the patients likely to have a long duration stay. Simple variables added to the current hospital minimum medical record would make it possible to consider a predictive approach.
OBJECTIVE: The implementation of Diagnosis Related Groups (DRG's) is intended to lead to a shortening of hospital days. DRG's therefore may endanger the quality of hospital care or cause a transfer of services from inward to ambulatory care. In this study the consequences of two selected DRG's are examined: operations of patients with varicosis and with hernia. METHODS: A retrospective comparison of 875 patient files in 6 hospitals in Northrhine-Westphalia (NRW) and a follow-up questionnaire to the patients themselves (N = 510). RESULTS: Between 1995 and 1997 average hospital days have been reduced by 2 days (varicosis) and 1 day (hernia) respectively. However, the standard stay according to an expert commission of the MOH is still exceeded. The shortening of inward care leads to an increase of ambulatory care. Also the patients indicate a worse subjective health status at discharge although this does not carry through the ambulatory phase. CONCLUSION: For the two DRG's examined the reduction of hospital services due to shorter inward periods is mostly compensated during ambulatory care. An additional shortening of hospital days, however, is likely to lead to negative effects on the health status of patients.
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