History Diagnosis Related Groups (DRGs) were developed in the late 1960s by American researchers in response to the rising cost of health care. DRGs provide a finance and patient classification system using diagnosis, type of treatment, age and other related factors as the screening criteria. Hospitals are paid a predetermined amount of money for treating patients from a given DRG, regardless o...

Pediatric-modified diagnosis-related groups (PM-DRGs) were designed to describe more accurately than DRGs differences in severity of illness and charges across pediatric patients. We report on an evaluation of PM-DRGs for use in prospective payment systems (PPSs). Data on pediatric discharges (i.e., patients 17 years of age or under) from 5 States and a national sample of 43 hospitals were used...

The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refined Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a ...

Public healthcare providers in all Spanish Regions - Autonomous Communities (ACs) use All Patients Diagnosis-Related Groups (AP-DRGs) for billing non-insured patients, cost accounting and inpatient efficiency indicators. A national migration to All Patients Refined Diagnosis-Related Groups (APR-DRGs) has been scheduled for 2016. The analysis was performed on 202,912 inpatient care episodes rang...

This paper reports the results of an evaluation study of the Australian National Diagnosis Related Groups (AN-DRGs). The evaluation was based on statistical rather than clinical criteria with the principal goal being to provide information for the future development of the classification system. As well as comparing versions 1.0 to 3.0 of AN-DRGs, the project included a comparison of these syst...

In October 1998, the definition of a transfer in Medicare's hospital prospective payment system was expanded to include several post-acute care (PAC) providers in 10 high-volume PAC diagnosis-related groups (DRGs). In this methodological article, the authors respond to a congressional mandate to consider more DRGs in the definition. Empirical results support expansion to many more DRGs that are...

There are a number of Diagnosis-Related Group (DRG) classification systems that have evolved over the past 2 decades, each with their own strengths and weaknesses. DRG systems are used for case-mix trending, utilization management and quality improvement, comparative reporting, prospective payment, and price negotiations. For any of these applications it is essential to know the accuracy with w...

given limited health sources, how to make drgs (diagnosis related groups) more feasible is a big question in developing countries. this study contributes to the debate on how to bridge the pay-for-service and drgs during the transitional period of payment reform.from 2008 to 2012, 20740 patients with cirrhosis or duodenal ulcer disease were chosen as sample. using multiple linear regression ana...

PURPOSE State-based Medicaid programs have begun using All Patient Refined-Diagnosis-Related Groups (APR-DRGs) to determine hospital reimbursement rates. Medicaid provides coverage for 45% of childhood cancer admissions. This study aimed to examine how well APR-DRGs reflect admission costs for childhood cancer chemotherapy to inform clinicians, hospitals, and policymakers in the wake of policy ...