Hospital in-patient activity evaluation in a pediatric cardiosurgery unit using All Patient Diagnosis Related Groups Classification System (AP-DRG) | Valutazione dell'attività di ricovero in cardiochirurgia pediatrica mediante il sistema di classificazione AP-DRG (all patient diagnosis related groups)

The evaluation of Health Care activities, particularly of those concerning hospitals, is one of the most important aims for the National Health Service for a "fair" resource allocation. In the recent past a great bulk of research has been directed to methods for patient classifications in relation to resource needs. Diagnosis Related Groups (DRG) is one of the most important patient classification systems related to resource allocation which has been developed in the U.S. Medicare Program (HCFA-DRGs) during the eighties and more recently adopted all over Europe, Italy included. Wide experimentation has been developed during the recent past concerning DRGs confirming its validity, but also has disclosed its limits, mostly concerning applicability outside U.S., identification of specific patient subgroups (like the pediatric patient population) and capability in distinguishing patients with apparently similar resource needs, but different clinical severity conditions. In order to overcome such limits, DRGs have been subjected to some important modification: All patient DRG (AP-DRG) is a system which should pay more attention to some patient subgroups, such as the pediatric one. Research is still looking for methods, easily extensible to the whole hospital informative system concerning the possibility of distinguishing patients with different level of severity condition. With the double aim of experiment the actual utility in the use of AP-DRG, more than HCFA-DRG in a pediatric population and find further indexes for complexity and/or severity characterization of the hospital case-mix, the 1992 in-patients hospital files of the pediatric cardiosurgery hospital CREAS-IFC-CNR was reviewed. Results confirm that some increase in the identification of the case-mix do occur by using the AP-DRG system, even if a better clinical characterization could be possible (i.e. AP-DRG 108). Of particular interest is the fact that descriptive statistical analysis of position and variability parameters do confirm the importance of the length of stay as a brief index for hospital efficiency evaluation and its organizative model characterization.