特集名 | クリニカルパスの透析医療への応用 | |
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題名 | 腎臓疾患のケースミックスとしてDRGは有効か? | |
発刊年月 | 2001年 05月 | |
著者 | 川渕 孝一 | 東京医科歯科大学大学院医療経済学分野 |
【 要旨 】 | 諸外国では,病院コストの違いを証明する指標,いわゆるケースミックスの開発が進んでいる.DRG(Diagnosis Related Group)もケースミックスのーつである.しかし,DRGといっても,一種類ではない.HCFA-DRG,AP-DRG,APR-DRG,そしてわが国の厚生省が急性期入院医療費の包括化の試行のために開発した,いわゆるJ-DRGなど,数多くのDRGが存在する.問題はこうしたDRGが腎臓疾患のケースミックスとして有効かどうかである. 本研究では,都合42病院から集めた281,218症例数を使って,在院日数に関するR2(決定係数)を求めたところ,腎臓疾患(MDC11)に関しては意外にもJ-DRGのR2値がもっとも高かった.しかし,R2値そのものの値は0.2179と必ずしも高くなく,現行のDRGにはいっそうの精緻化が求められる. |
Theme | Application of Clinical Path for Dialysis Treatment | |
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Title | Is DRG applicable as casemix complexity in patients with kidney disease? | |
Author | Koichi Kawabuchi | Graduate School, Tokyo Medical and Dental University |
[ Summary ] | The development of casemix complexity has been conducted to explain the variations of hospital costs. DRG (Diagnosis Related Group) is one of the casemix complexity. However, there are several alternative DRG systems such as HCFA-DRG, AP-DRG (All patient DRG), APR-DRG (All-Patient Refined DRG), and also the Japanese DRG (J-DRG) developed by Ministry of Health and Welfare in order to conduct the pilot study on DRG/PPS (Prospective Payment System). The question is whether these DRGs are applicable as casemix complexity of patients with kidney disease. In our research, while using the patients discharge database which contains 281, 218 cases collected from 42 hospitals, we have computed the reduction of variance (R2) on length of stay. As far as MDC11 (Major Diagnostic Category 11) is concerned, we have found that J-DRG is unexpectedly one of the most suitable among alternative DRG. However, we need further refinement of DRG since its R2 is only 0.2179 and relatively low. |