DRG Inclusion

HPR Technical Report - DRG Inclusion

The fifteen DRGs included in the 1998 Report were selected primarily by patient volume, mortality rate, and mortality rate variability among hospitals.

Since the 1998 Report includes data from acute care facilities regardless of bed size, DRGs were selected that are prevalent at smaller facilities as well as at larger facilities. The fifteen selected DRGs not only represent a broad range of Major Diagnostic Categories (MDCs), but also represent both medical and surgical DRGs. MDCs included in the analysis represent different body systems, including Nervous system (01), Respiratory system (04), Circulatory system (05), Digestive system (06), Musculoskeletal system and connective tissue (08), Endocrine, nutritional and metabolic (10), Kidney and urinary tract (11), and Infectious and parasitic diseases (18).

Assignments to a DRG usually do not capture all cases with a given diagnosis/procedure. Cases assigned to a DRG typically represent a subset of all patients with a specific diagnosis or surgical treatment that are more homogeneous with regard to resource use and clinical complexity.

The fifteen DRGs included in the 1998 Hospital Performance Report are:

DRG	Description	Common Names	MDC	Medical/ Surgical
14	Specific Cerebrovascular Disorders Except Transient Ischemic Attack	Stroke (Brain Attack)	01	Medical
79	Respiratory Infections and Inflammations, Age Greater Than 17 with CC^‡	Adult Lung Infections	04	Medical
82	Respiratory Neoplasms	Lung Cancer	04	Medical
89	Simple Pneumonia with Pleurisy, Age Greater Than 17 with CC^‡	Adult Pneumonia	04	Medical
110	Major Cardiovascular Procedures with CC^‡	Major Vessel Operations Except Heart	05	Surgical
121-123*	Medical Treatment - Acute Myocardial Infarction	Medical Heart Attack	05	Medical
127	Heart Failure and Shock	Heart Failure and Shock	05	Medical
130	Peripheral Vascular Disorders with CC^‡	Vascular Disorders Except Heart	05	Medical
148	Major Small and Large Bowel Procedures with CC^‡	Major Intestinal Procedures	06	Surgical
174	GI Hemorrhage with CC^‡	Gastrointestinal Bleeding	06	Medical
210	Hip and Femur Procedures Except Major Joint Procedures, Age Greater Than 17 with CC^‡	Hip Operations Except Replacements	08	Surgical
294	Diabetes, Age Greater Than 35	Adult Diabetes	10	Medical
316	Renal Failure	Kidney Failure	11	Medical
416	Septicemia, Age Greater Than 17	Adult Septicemia	18	Medical
478	Other Vascular Procedures with CC^‡	Vascular Operations Except Heart	05	Surgical

^{‡ CC – complication or
comorbid condition

* Because
medically-treated heart attack patients who die are given a separate DRG (123),
DRGs for all medical heart attack patients were combined for the mortality
analysis. Hospital charges for these combined DRGs were case-mix adjusted to
provide equitable comparisons. Not all AMI cases are captured in these DRGs. AMI
patients transferred to another acute care facility have been excluded and AMI
patients treated with therapeutic intervention (i.e., CABG, PTCA, and/or stent)
are not captured. Approximately 25 percent of acute care hospitals have the
capability to provide these therapeutic interventions.}