HOW WELL DO DIAGNOSIS‐RELATED GROUPS FOR APPENDECTOMY EXPLAIN VARIATIONS IN RESOURCE USE? AN ANALYSIS OF PATIENT‐LEVEL DATA FROM 10 EUROPEAN COUNTRIES
分析了10个欧洲国家106,929例阑尾切除术患者数据，评估诊断相关分组（DRG）和患者特征对住院费用或住院时长变异的解释能力，发现各国DRG系统表现差异大，且存在资源管理不佳的医院。
Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106,929 appendectomy patients treated in 939 hospitals in 10 European countries. In stage 1, we tested the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length of stay (three countries). The first model used only the diagnosis-related groups (DRGs) to which patients were coded, the second model used a core set of general patient-level and appendectomy-specific variables, and the third model combined both sets of variables. In stage two, we investigated hospital-level variation. In classifying appendectomy patients, most DRG systems take account of complex diagnoses and comorbidities but use different numbers of DRGs (range: 2 to 8). The capacity of DRGs and patient-level variables to explain patient-level cost variation ranges from 34% in Spain to over 60% in England and France. All DRG systems can make better use of administrative data such as the patient's age, diagnoses and procedures, and all countries have outlying hospitals that could improve their management of resources for appendectomy.