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How well do diagnosis-related groups explain variations in costs or length of stay among patients and across hospitals? Methods for analysing routine patient data

Author

Listed:
  • Andrew Street

    (CHE - Center for Health Economics - University of York [York, UK])

  • Conrad Kobel

    (IMU - Innsbruck Medical University [Austria])

  • Thomas Renaud

    (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Institut de la Recherche et Documentation en Economie de la Santé)

  • Josselin Thuilliez

    () (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)

Abstract

We set out an analytical strategy to examine variations in resource use, whether cost or length of stay, of patients hospitalised with different conditions. The methods are designed to evaluate (i) how well diagnosis-related groups (DRGs) capture variation in resource use relative to other patient characteristics and (ii) what influence the hospital has on their resource use. In a first step, we examine the influence of variables that describe each individual patient, including the DRG to which the patients are assigned and a range of personal and treatment-related characteristics. In a second step, we explore the influence that hospitals have on the average cost or length of stay of their patients, purged of the influence of the variables accounted for in the first stage. We provide a rationale for the variables used in both stages of the analysis and detail how each is defined. The analytical strategy allows us (i) to identify those factors that explain variation in resource use across patients, (ii) to assess the explanatory power of DRGs relative to other patient and treatment characteristics and (iii) to assess relative hospital performance in managing resources and the characteristics of hospitals that explain this performance.

Suggested Citation

  • Andrew Street & Conrad Kobel & Thomas Renaud & Josselin Thuilliez, 2012. "How well do diagnosis-related groups explain variations in costs or length of stay among patients and across hospitals? Methods for analysing routine patient data," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00719777, HAL.
  • Handle: RePEc:hal:cesptp:halshs-00719777
    DOI: 10.1002/hec.2837
    Note: View the original document on HAL open archive server: https://halshs.archives-ouvertes.fr/halshs-00719777
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    Cited by:

    1. Francesc Cots & Pietro Chiarello & Xavier Salvador & Xavier Castells & on behalf of the EuroDRG group, 2012. "Patient Classification Systems And Hospital Costs Of Care For Knee Replacement In 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 116-128, August.
    2. James Gaughan & Conrad Kobel & Caroline Linhart & Anne Mason & Andrew Street & Padraic Ward & on behalf of the EuroDRG group, 2012. "Why Do Patients Having Coronary Artery Bypass Grafts Have Different Costs Or Length Of Stay? An Analysis Across 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 77-88, August.
    3. Chris Bojke & Katja Grasic & Andrew Street, 2015. "How much should be paid for Prescribed Specialised Services?," Working Papers 118cherp, Centre for Health Economics, University of York.
    4. Chris Bojke & Katja Grašič & Andrew Street, 2018. "How should hospital reimbursement be refined to support concentration of complex care services?," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 26-38, January.
    5. Unto Häkkinen & Pietro Chiarello & Francesc Cots & Mikko Peltola & Hanna Rättö & ON BEHALF OF THE EURODRG GROUP, 2012. "Patient Classification And Hospital Costs Of Care For Acute Myocardial Infarction In Nine European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 19-29, August.
    6. Carine Milcent, 2016. "Upcoding and heterogeneity in hospitals’ response: A Natural Experiment," Working Papers halshs-01340557, HAL.
    7. Anne Mason & Zeynep Or & Thomas Renaud & Andrew Street & Josselin Thuilliez & Padraic Ward & ON BEHALF OF THE EURODRG GROUP, 2012. "How Well Do Diagnosis‐Related Groups For Appendectomy Explain Variations In Resource Use? An Analysis Of Patient‐Level Data From 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 30-40, August.
    8. Alexander Geissler & David Scheller‐Kreinsen & Wilm Quentin & on behalf of the EuroDRG group, 2012. "Do Diagnosis‐Related Groups Appropriately Explain Variations In Costs And Length Of Stay Of Hip Replacement? A Comparative Assessment Of Drg Systems Across 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 103-115, August.
    9. Jacqueline O'Reilly & Lisbeth Serdén & Mats Talbäck & Brian McCarthy & on behalf of the EuroDRG group, 2012. "Performance Of 10 European Drg Systems In Explaining Variation In Resource Utilisation In Inguinal Hernia Repair," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 89-101, August.
    10. Zeynep Or & Thomas Renaud & Josselin Thuilliez & Cora Lebreton & on behalf of the EuroDRG group, 2012. "Diagnosis Related Groups And Variations In Resource Use For Child Delivery Across 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 55-65, August.
    11. Martin, Stephen & Street, Andrew & Han, Lu & Hutton, John, 2016. "Have hospital readmissions increased in the face of reductions in length of stay? Evidence from England," Health Policy, Elsevier, vol. 120(1), pages 89-99.
    12. Reinhard Busse & on behalf of the EuroDRG group, 2012. "DO DIAGNOSIS‐RELATED GROUPS EXPLAIN VARIATIONS IN HOSPITAL COSTS AND LENGTH OF STAY? – ANALYSES FROM THE EURODRG PROJECT FOR 10 EPISODES OF CARE ACROSS 10 EuroPEAN COUNTRIES," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 1-5, August.
    13. Gianluca Fiorentini & Silvana Robone & Rossella Verzulli, 2018. "How do hospital‐specialty characteristics influence health system responsiveness? An empirical evaluation of in‐patient care in the Italian region of Emilia‐Romagna," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 266-281, February.
    14. Gerli Paat‐Ahi & Maria Świderek & Paweł Sakowski & Janek Saluse & Ain Aaviksoo & on behalf of the EURODRG group, 2012. "DRGs IN EUROPE: A CROSS COUNTRY ANALYSIS FOR CHOLECYSTECTOMY," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 66-76, August.
    15. Häkkinen, Unto & Rosenqvist, Gunnar & Peltola, Mikko & Kapiainen, Satu & Rättö, Hanna & Cots, Francesc & Geissler, Alexander & Or, Zeynep & Serdén, Lisbeth & Sund, Reijo, 2014. "Quality, cost, and their trade-off in treating AMI and stroke patients in European hospitals," Health Policy, Elsevier, vol. 117(1), pages 15-27.
    16. Mikko Peltola & on behalf of the EuroDRG group, 2012. "Patient Classification And Hospital Costs Of Care For Stroke In 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 129-140, August.
    17. Bernal-Delgado, Enrique & Comendeiro-Maaløe, Micaela & Ridao-López, Manuel & Sansó Rosselló, Andreu, 2020. "Factors underlying the growth of hospital expenditure in Spain in a period of unexpected economic shocks: A dynamic analysis on administrative data," Health Policy, Elsevier, vol. 124(4), pages 389-396.
    18. Thanassoulis, Emmanuel & Silva Portela, Maria & Graveney, Mike, 2016. "Identifying the scope for savings at inpatient episode level: An illustration applying DEA to chronic obstructive pulmonary disease," European Journal of Operational Research, Elsevier, vol. 255(2), pages 570-582.
    19. David Scheller‐Kreinsen & on behalf of the EuroDRG group, 2012. "How Well Do Diagnosis‐Related Group Systems Group Breast Cancer Surgery Patients?—Evidence From 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 41-54, August.

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