13th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 1998

January 24-31, 1998
Marilleva, Trento, Italy

RT-89

Is DRG 112 homogeneous in the use of resources with regard to arrhythmology? A proposed methodology of evaluation

Catherine Klersy¹, Arturo Raisaro², Alberto Bonoldi³, Jorge A. Salerno Uriarte⁴.
¹Biometric Unit-Scientific Direction, ²Division of Cardiology and ³Hospital Direction, IRCCS Policlinico San Matteo, ⁴University of Pavia, Italy

Abstract

American DRGs have been recently introduced in Italy to meas-ure productivity and to finance hospitals. However in some cases a sole tariff may miss the variability which is implicitly included in a single DRG. This is particularly true when considering DRG 112, in which hospital admissions are classified according to a wide series of procedures and which is of particular interest for arrhythmology.

Aim of this study is to quantify the costs distribution within DRG 112, with a particular regard to arrhythmologic proced-ures. An analytical quantification of costs within DRG 112 has been performed through the French "Catalog of Medical Acts" (CMA). At this purpose all 620 discharges within DRG 112 from the cardiology division of a reference hospital within year 1996 have been retrieved. An estimation of resource use in French relative cost index (RCI) units was calculated. RCI distribution for DRG 112 has been visually assessed on a bar plot; single procedure RCI have been compared by analysis of variance. Finally type of procedure, age at admission and length of stay have been fitted in a multivariate linear regression model, with RCI as the dependent variable, to identify sources of variabi-lity for the resource use within DRG 112. Total costs in these series amount to 173 600 RCI units for DRG 112. Bar plot shows multimodal distribution of RCI within DRG 112. Analysis of variance elicits a significant difference (p = 0.001) among proced-ures. At multiple regression length of stay as well as type of procedure appear to be independent sources of variability for costs expressed in RCI units. In conclusion, this study indicates that resource use within DRG 112 is quite dishomogeneous, particularly when considering arrhythmias ablation. The French system of relative cost index appears to be a useful tool as a shorthand for estimating resource use and analyzing its distribution.

Key Words

Cardiac arrhythmias - epidemiology  
public health system, DRGs, hospital productivity, analysis of resource use, financing hospitals, Catalog of Medical Acts, USA, Italy, France, OA