1 EuroDRG FC Busse Berlin171111

Diagnosis Related Groups in Europe:
Moving towards transparency, efficiency

and quality in hospitals
Understanding DRGs in Europe the EuroDRG project
Reinhard Busse, Prof. Dr. med. MPH FFPH
Department of Health Care Management, Berlin University of Technology
& European Observatory on Health Systems and Policies
on behalf of the EuroDRG team
17 November 2011
DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals
How I got interested in DRGs (2002)
A policy question in the 6th EU Framework Programme:

Why do costs of health services differ among EU countries at
the micro level?
The first nine patients sent to

France by the English NHS
(not shown: the 40 journalists
who accompanied them)
9,000
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
NHS
UK private
France
Cataract
Hip
Knee
Are these data realistic?

Are they representative?
How can the differences be explained?
17 November 2011
10000,00
in
Using 10 standardised vignettes across

countries
E.g. Acute myocardial infarction
9374,21
9000,00
8282,36
8000,00
7616,89
7450,22
7000,00
6225,55
5916,45
6000,00
5369,53
5000,00
5599,30
5013,64
4161,15
4384,72
4000,00
3720,88
3000,00
2541,845
2000,00
2733,38
2465,32
2236,40
2866,36
2868,16
1861,02
1000,00
483,05
395,97
308,88
1415,79
1025,76
592,15
1282,55
1181,53
0,00
Hungary
(N=2)
17 November 2011
Poland
(N=5)
Spain
(N=5)
Denmark
(N=3)
Germany
(N=13)
England
(N=3)
France
(N=3)
Netherlands
(N=6)
Italy
(N=5)
10000,00
in
patient variables
Acute myocardial infarction

9374,21
9000,00
8000,00
gender, age,
main diagnosis, other
diagnoses, severity
8282,36
7616,89
7450,22
7000,00
6000,00
medical and management

decision variables
Open question 1: How much do

these variables contribute to cost
variation (and do DRG systems
take them into account)?
6225,55
5916,45
5369,53
5000,00
4000,00
mix and intensity of procedures,

technologies and human
resource use
5599,30
5013,64
4161,15
4384,72
3720,88
3000,00
2541,845
2000,00
2733,38
2465,32
2236,40
2866,36
structural variables on
2868,16
hospital/ regional/
national level
1861,02
1000,00
483,05
395,97
308,88
1415,79
1025,76
592,15
1282,55
1181,53
e.g. size, teaching status;

urbanity; wage level
0,00
Hungary
(N=2)
17 November 2011
Poland
(N=5)
Spain
(N=5)
Denmark
(N=3)
Germany
(N=13)
England
(N=3)
France
(N=3)
Netherlands
(N=6)
Italy
(N=5)
Acute myocardial infarction:

10000,00
in
Hospitals performing PCI (PTCA/ Stenting)
9000,00
none
mixed
9374,21
all
8282,36
8000,00
7616,89
7450,22
7000,00
6225,55
5916,45
6000,00
5369,53
5000,00
4000,00
5599,30
5013,64
> factor 4:
value for money?
4161,15
4384,72
3720,88
3000,00
2541,845
2000,00
2733,38
2465,32
2236,40
2866,36
2868,16
1861,02
1000,00
483,05
395,97
308,88
1415,79
1025,76
592,15
1282,55
1181,53
0,00
Hungary
(N=2)
17 November 2011
Poland
(N=5)
Spain
(N=5)
Denmark
(N=3)
Germany
(N=13)
England
(N=3)
France
(N=3)
Netherlands
(N=6)
Italy
(N=5)
Acute myocardial infarction:

infarction
10000,00
in
Hospitals performing PCI (PTCA/ Stenting)

none
9000,00
mixed
9374,21
all
8282,36
8000,00
7616,89
7450,22
7000,00
Open question 2: If costs differ so

much with treatment, what about
the quality of care?
6225,55
5916,45
6000,00
5369,53
5000,00
5599,30
5013,64
4161,15
4000,00
4384,72
3720,88
3000,00
2541,845
2000,00
2733,38
2465,32
2236,40
2866,36
2868,16
1861,02
1000,00
483,05
395,97
308,88
1415,79
1025,76
592,15
1282,55
1181,53
0,00
Hungary
(N=2)
17 November 2011
Poland
(N=5)
Spain
(N=5)
Denmark
(N=3)
Germany
(N=13)
England
(N=3)
France
(N=3)
Netherlands
(N=6)
Italy
(N=5)
Hip implant
12000
Reimbursement (Euros)
10000
8000
Hospitals in NL
6000
Denmark
England
France
Germany
Hungary
Italy
Netherlands
Poland
Spain
4000
2000
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Total cost (Euros)
17 November 2011
Hip implant
12000
Profit-making
plausible through3:
comparatively
low case
complexityso much
Open
question
If costs
differ
within countries, why do countries
develop their own DRG systems
(rather than a European one)?
What data would be necessary for this?
Reimbursement (Euros)
10000
8000
6000
Denmark
England
France
Germany
Hungary
Italy
Netherlands
Poland
Spain
4000
2000
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Total cost (Euros)
17 November 2011
For the new project, we then chose to look at

DRGs specifically. These are introduced to get a
common currency of hospital activity for
transparency
efficiency benchmarking &
performance measurement (protect/ improve quality),
budget allocation (or division among purchasers),
planning of capacities,
payment ( efficiency)
Exact reasons, expectations and DRG usage differ

among countries due to (de)centralisation, one
vs. multiple payers, public vs. mixed ownership.
17 November 2011
Suomi
Finland
Countries
bytransparency,
EuroDRG
project
DRGs covered
in Europe: Moving towards
efficiency and
17 November 2011
quality in hospitals
10
What did we do?
Phase I (= session I today)

How do DRG system in Europe work? Why and when
implemented? How does patient classification work?
Where do data come from? Uniform or regionally adapted?
How often updated? Impact on efficiency and quality?
Phase II (= session II today)

How do DRG systems perform? To empirically analyse that,
we chose 10 episodes of care for across-country
comparisons of actual classification, reimbursement, factors
explaining cost variation, cost-quality relationship
Phase III (= this afternoon)

Conclusions for policy-makers within and beyond European
countries
17 November 2011
11
EoC and related questions
Finland - THL
England - CHE
Austria - MSIG
Netherlands - iBMG
Recommended for inclusion?

(yes/no)

(yes/no)

(yes/no)

(yes/no)
Poland - NHF
Can you differentiate the

following items?
(yes/no)
Remarks

(yes/no)
Spain - IMAS
Germany - TUB
Sweden - CPK

(yes/no)

(yes/no)

(yes/no)
YES
yes, but cannot identify disease stage
1. Breast cancer
Types of carcinoma (invasive and not invasive)
no
NO - CANNOT IDENTIFY DISEASE STAGE,

SO COMPARABILITY PROBLEMATIC
yes, however we should explicitly in- or exclude

certain treatments.
We could have a clear picture of breast cancer.

Yes
ICD10
Stages of the disease (TNM, IUCC ), grade of the disease (G1-G4)

No
Protein and gene expression status (oestrogen receptor (ER),
progesterone receptor (PR) and HER2/neu proteins)
No
Types of treatment: surgery, radiation, hormone immune and

chemotherapy
Yes
excluding hormone immune
Types of surgery: tumourectomy, mastectomy - with or without
lymph-adenectomy and reconstruction
Yes
ICD9
yes
2. Colorectal cancer
Location of the cancer, i.e. in the colon (possibly further specified), no
rectum and caecum
NO - CANNOT IDENTIFY DISEASE STAGE,

SO COMPARABILITY PROBLEMATIC
yes, but a detailed definition is required
We could have a clear picture of colorectal cancer.

However, we can not identify patients who had both
surgery and chemotherapy.
YES
yes, but cannot identify disease stage
YES
yes
YES
yes
NO or maybe we think about redefining

parameters of the episode
yes
NO or maybe we think about redefining

parameters of the episode
yes, but some difficulties
YES
yes
Yes
ICD10
Stages of the cancer (TNM, IUCC, Dukes classification ), grade of

the disease (G1-G4)
No
Types of treatment: surgery, radiation, chemotherapy

Yes
ICD9
Extent of surgery (both within colon/ rectum and other organs)
Yes
yes
ICD9
3. Diabetes mellitus
Types of diabetes (type 1 and type 2)
yes,
although is complicated
NO
yes
It is rather difficult to get a clear picture of diabetes

mellitus, predominantly owing to the many
departments involved and the inability to link them.
Yes
Reason for admission (e.g. hyperglycaemic or hypoglycaemic

shock; other complications),
Yes
Procedures related to the main diagnosis diabetes (e.g.

amputation)
Yes
yes
4. Acute myocardial infarction (AMI)
Type of acute myocardial infarction (both ST-elevated MI [STEMI] yes

and non-ST-elevated MI [NSTEMI])
YES
yes
We could have a clear picture of acute myocardial

infarction, except when it comes to CABG procedures.
Yes
Treatment (PTCA, stent, CABG/bypass)

Yes
ICD9
yes
5. Percutaneous coronary interventions (PCI)
Indications for PCI

Treatment (PTCA, stent)
yes,
YES
requires exact definition of procedure
codes in order to secure comparability
between countries
yes
We could have a clear picture of PCI procedures.

However, the number of diagnosis-codes may turn
out to be too extensive/ complex to work with.
Yes
Yes
ICD9
Location of intervention (number of vessels treated, affected

coronary artery, bifurcation )
Yes
ICD9
Details of stent (bare metal vs. drug-eluting; number of stents,
affected coronary artery, type of drug on DES )
Yes
ICD9
yes
6. Coronary artery bypass graft surgery (CABG)
Indications for CABG

Grafting of both types of blood vessels: arteries and veins
yes,
YES
requires exact definition of procedure
codes in order to secure comparability
between countries
yes
We could have a clear picture of CABG procedures.

However, we can not distinguish the underlying
diagnoses (such as acute myocardial infarction).
Yes
No
Type of surgery: with the usage of cardiopulmonary bypass or socalled off-pump surgery
Yes
yes
7. Stroke
Cause (due to ischemia (thrombosis or embolism) or
haemorrhage)
yes
YES
yes
We could have a clear picture of stroke.

Yes
ICD10
Treatment settings (ICU, stroke unit or medical/ neurological

ward)
Yes
Rehabilitation within operating hospital or associated settings (vs.

rehabilitation after transfer, i.e. after end of episode)
No
yes
8. Community-acquired pneumonia
Hospital-acquired pneumonia (nosocomial) (e.g. by special code or no

present on admission code)
NO
yes
It is rather difficult to get a clear picture of

community-acquired pneumonia, because we can not
distinguish between hospital and community-acquired
pneumonia.
yes, but no information on type of antibiotics used

for treatment
No
Treatment settings (ICU or medical ward)

No
Type of treatment (especially antibiotics)
No
9. Inguinal hernia repair
Type of inguinal hernia (bilateral unilateral, direct indirect)
yes
YES
yes, should we define a minimal age?
It is rather difficult to get a clear picture of inguinal

hernia repair, because we can not distinguish
between hernia femoralis and inguinalis.
YES
yes but not possible to identify direct/indirect
YES
yes
YES
yes
YES
yes, but difficult to know numbers for

rehabilitation
Yes
Type of surgical repair (with or without graft or prosthesis

implant)
Yes
Treatment setting (inpatient, outpatient)

Yes
yes
inpatient only
10. Appendectomy
Type of surgery (laparoscopic or open)
yes
YES
yes
We could have a clear picture of appendectomy.

Yes

Yes
inpatient only
yes
11. Cholecystectomy
Type of surgery (laparoscopic or open)
yes
YES
yes
It is rather difficult to get a clear picture of

cholecystectomy. However, we could have a clear
picture of cholecystitis.
Yes

Yes
inpatient only
yes
12. Hip replacement

Indication (osteoarthritis, other types of arthritis, protrusio
acetabuli, avascular necrosis, hip fractures and benign and
malignant bone tumours)
yes
YES
yes
We could have a clear picture of hip replacement.

However, we can not always distinguish the
underlying diagnoses.
Yes
ICD10
Type of replacement (e.g. hemiprosthesis, total endoprosthesis,
resurfacing)
Yes
Type of surgery (cemented, cementless and hybrid prosthesis)

Yes
First replacement vs. revision
Yes
Rehabilitation within operating hospital or associated settings (vs.

rehabilitation after transfer, i.e. after end of episode)
No
yes
17 November 2011
Selected episodes of care:

Appendectomy
Cholecystectomy
AMI
Bypass (CABG)
Stroke
Inguinal hernia
Hip replacement
Knee replacement
Breast cancer
Childbirth
Dropped:
Colorectal cancer
Diabetes
Com.-acq. Pneumonia
Urolithiasis
Traumatic brain injury
12
For what types of activities? Scope of DRGs (I)
Excluded costs
(e.g. for infrastructure; in U.S. also physician services)
Payments for non-patient care activities
(e.g. teaching, research, emergency availability)
Payments for patients not classified into DRG system
(e.g. outpatients, day cases, psychiatry, rehabilitation)
Additional payments for specific activities for DRGclassified patients (e.g. expensive drugs, innovations),
possibly listed in DRG catalogues
Other types of payments for DRG-classified patients

(e.g. global budgets, fee-for-service)
DRG-based case payments,

DRG-based budget allocation
(possibly adjusted for outliers, quality etc.)
17 November 2011
13
For what types of activities? Scope of DRGs (II)
DRG system
(included in or
separate from
original DRGs)
Psychiatry
17 November 2011
DRG system
(identical or
different to
original DRGs)
Original
DRG
systems
DRG system
(included in or
separate from
original DRGs)
DRG system
(included in or
separate from
originalDRGs)
Day cases
Acute
inpatient care
Outpatient care
Rehabilitation
14
Essential building blocks of DRG systems
Data collection
Demographic data
Clinical data
Cost data
Sample size,
regularity
Import
Patient
classification
system
Price setting
Actual
reimbursement
Cost weights
Volume limits
Base rate(s)
Prices/ tariffs
Average vs. best
Outliers
High cost cases
Quality
Innovations
Negotiations
Diagnoses
Procedures
Severity
Frequency of revisions
17 November 2011
15
Hospital payment systems

DRGs for payment: Advantages and disadvantages
of different forms of hospital payment
Activity
Expenditure
Control
Technical
Efficiency
Quality
Administrative
simplicity
Transparency
Number of
services per
case
Number
of cases
Fee-forservice
Global
budget
17 November 2011
16
Hospital payment systems

DRGs for payment: Advantages and disadvantages
of different forms of hospital payment
dumping (avoidance), creaming
(selection) and skimping (undertreatment)
up/wrong-coding, gaming
Activity
Expenditure
Control
Technical
Efficiency
Administrative
simplicity
Transparency
Number of
services per
case
Number
of cases
Fee-forservice
USA
0 1980s
-
DRGbased
payment
Global
budget
17 November 2011
Quality
0 European
0
+
countries 1990s/2000s
17
Main questions relating to data collection
Clinical data
classification system for diagnoses and
classification system for procedures
Data collection
Demographic data
Clinical data
Cost data
Sample size,
regularity
Cost data
imported (not good but easy) or
collected within country (better but needs
standardised cost accounting)
Sample size
entire patient population or
a smaller sample
Many countries: clinical data = all patients;
cost data = hospital sample
with standardised cost accounting system
17 November 2011
18
Data collection
Collection of cost data
Austria
England
Estonia
Finland
France
Germany
Ireland
Poland
Portugal
The Netherlands
Spain
Sweden
17 November 2011
Number (share) of cost

data collecting hospitals
20 reference hospitals
(~8% of all hospitals)
all hospitals
All hospitals contracted by
the NHIF
(~30% of specialised care)
99 hospitals (~ 13% of
inpatient admissions)
125 hospitals
(~ 6% of all hospitals)
unit costs: 15-25 hospitals
(~ 62% of inpatient
admissions)
Demographic data
Clinical data
Cost data
Sample size,
regularity
Direct cost
allocation to patients
Data used for calculation of

DRG weights
grosscosting
top down microcosting
bottom up microcosting
mainly top down

microcosting
mainly bottom up
microcosting
-
x
x
-
19
Data collection
Collection of cost data
Austria
England
Estonia
Finland
France
Germany
Ireland
Poland
Portugal
The Netherlands
Spain
Sweden
17 November 2011
Number (share) of cost

data collecting hospitals
(~8% of all hospitals)
all hospitals
All hospitals contracted by
the NHIF
(~30% of specialised care)
99 hospitals (~ 13% of
inpatient admissions)
125 hospitals
Demographic data
Clinical data
Cost data
Sample size,
regularity
Direct cost
allocation to patients
Data used for calculation of

DRG weights
grosscosting
mainly top down

microcosting
mainly bottom up
microcosting
x
x
Imported DRG systems and weights (or with only minor modifications)
unit costs: 15-25 hospitals
Imported DRG systems and weights
(~ 62% of inpatient
admissions)
x
20
How to calculate costs and set prices fairly (I)

Based on good quality data (not possible if
cost weights imported)
Price setting
Cost weights
Base rate(s)
Prices/ tariffs
Average vs. best
Average costs vs. best practice

Cost weights x base rate vs. Tariff + adjustment
cost weight
(varies by DRG)
Score (e.g. England)
Raw tariff
(e.g. France)
Relative weight
(e.g. Germany)
17 November 2011
base rate or
adjustment
1.0 1.32
(varies by hospital)
3000
3000
1.0 (+/-)
X (varies by region and
hospital)
1.0
3000 (+/-)
X (varies slightly by state)
21
How to calculate costs and set prices fairly (II)

Country
Austria
Nationwide
England
Raw tariff
Nationwide
Estonia
Relative weight
Nationwide
Finland
Relative weight
Nationwide (8 districts), District-specific (5 districts)
France
Raw tariff
Nationwide (separate tariffs for public and private hospitals)
Germany
Relative weight
Nationwide
Ireland
(Adapted) Relative weight
Netherlands
Raw tariff
Poland
Score
Portugal
(Adapted) Relative weight
Nationwide
(separate weights for paediatric hospitals)
Nationwide (67% of DRGs),
hospital-specific (33% of DRGs)
Nationwide (separate tariffs for emergencies, elective cases,
day cases)
Nationwide
Spain
(Catalonia)
(1) (Adapted) Raw tariff

(AP-DRGs);
(2) (Imported) Relative weight
(CMS-DRGs)
Relative weight
Sweden
17 November 2011
Applicability of DRG weight
Price setting
DRG weight
(unit)
Score
Cost weights
Base rate(s)
Prices/ tariffs
Average vs. best
(1) Nationwide
(AP-DRGs)
(2) Region-wide (CMS-DRGs)
Nationwide, county-specific (some counties)
22
How European DRG systems reduce unintended

behaviour: 1. long- and short-stay adjustments
Revenues
Actual
reimbursement
Short-stay
outliers
Inliers
Long-stay
outliers
Volume limits
Outliers
High cost cases
Quality
Innovations
Negotiations
Deductions
(per day)
Lower LOS
threshold
17 November 2011
Surcharges
(per day)
LOS
Upper LOS
threshold
23

behaviour: 2. Fee-for-service-type additional payments
Actual
reimbursement
Volume limits
England
France
Germany
Netherlands
Payments per
hospital stay
One
One
One
Several
possible
Payments for
specific highcost services
Unbundled
HRGs for e.g.:
Chemotherapy
Radiotherapy
Renal dialysis
Diagnostic
imaging
High-cost drugs
Sances GHM for

e.g.:
Chemotherapy
Radiotherapy
Renal dialysis
Supplementary
payments for e.g.:
Chemotherapy
Radiotherapy
Renal dialysis
Diagnostic imaging
High-cost drugs
No
Yes
Yes
Yes
Yes (for
drugs)
Outliers
High cost cases
Quality
Innovations
Negotiations
Innovationrelated addl
payments
17 November 2011
Additional
payments:
ICU
Emergency care
High-cost drugs
24

behaviour: 3. adjustments for quality
Actual
reimbursement
Volume limits
Outliers
High cost cases
Quality
Innovations
Negotiations
England & Germany: no extra payment if

patient readmitted within 30 days
Germany: deduction for not submitting quality
data
England: up 1.5% reduction if quality
standards are not met
France: extra payments for quality
improvement (e.g. regarding MRSA)
17 November 2011
25
4. Frequent revisions of PCS and payment rates

Country
PCS
Payment rate
Frequency of updates
Time-lag to data
Frequency of updates
Time-lag to data
Austria
Annual
24 years
45 years
24 years
England
Annual
Minor revisions annually; irregular
Annual
3 years (but adjusted for
overhauls about every 56 years

Estonia
Irregular (first update
inflation)
12 years
Annual
12 years
after 7 years)
Finland
Annual
1 year
Annual
01 year
France
Annual
1 year
Annual
2 years
Germany
Annual
2 years
Annual
2 years
Ireland
Every 4 years
Not applicable (imported
Annual
12 years
Annual or when
2 years, or based on
considered necessary
negotiations
Annual update only of
1 year
AR-DRGs)
Netherlands
Poland
Irregular
Not standardized
Irregular planned
1 year
twice per year

Portugal
Irregular
base rate
Irregular
23 years
Annual
23 years
Annual
2 years
AP-DRGs)
Spain (Catalonia)
Biennial

3-year-old CMS-DRGs)
Sweden
Annual
17 November 2011
12 years
26
How do DRG systems deal with innovations?
Actual
reimbursement
Volume limits
Outliers
High cost cases
Quality
Innovations
Negotiations
17 November 2011
27
Conclusions so far
DRG-based hospital payment is the main method of provider
payment in Europe, but systems vary across countries
Different patient classification systems
DRG-based budget allocation vs. case-payment
Regional/local adjustment of cost weights/conversion rates
To address potential unintended consequences, countries
implemented DRG systems in a step-wise manner

operate DRG-based payment together with other payment mechanisms
refine patient classification systems continously (increase number of groups)
place a comparatively high weight on procedures
base payment rates on actual average (or best-practice) costs
reimburse outliers and and high cost services separately
update both patient classification and payment rates regularly
If done right (which is complex), DRGs can contribute to increased

transparency and efficiency and possibly quality
17 November 2011
28
EuroDRG project partners

Austria
England/ UK
Department for Medical Statistics, Informatics and Health Economics, Innsbruck

Medical University
Centre for Health Economics, University of York
Estonia
PRAXIS Center for Policy Studies, Tallinn
Europe
European Health Management Association, Brussels
Finland
National Institute for Health and Welfare , Helsinki
France
cole des hautes tudes en sant publique, Rennes &

Institut de recherche et documentation en conomie de la sant, Paris
Germany
Department of Health Care Management, Technische Universitt Berlin
Ireland
Netherlands
Poland
Portugal
Spain
Sweden
17 November 2011
Economic and Social Research Institute, Dublin

Institute for Health Policy & Management, Erasmus Universitair Medisch Centrum
Rotterdam
National Health Fund, Warsaw
Avisory board member Cu Mateus
Institut Municipal dAssistncia Sanitria, Barcelona
Centre for Patient Classification, National Board of Health and Welfare, Stockholm
29
EuroDRG consortium members
Picture: 22nd January 2010, Paris

17 November 2011
30

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Diagnosis Related Groups in Europe:

Moving towards transparency, efficiency

on behalf of the EuroDRG team

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

How I got interested in DRGs (2002)

A policy question in the 6th EU Framework Programme:

The first nine patients sent to

Are these data realistic?

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

Using 10 standardised vignettes across

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

Acute myocardial infarction

medical and management

Open question 1: How much do

mix and intensity of procedures,

e.g. size, teaching status;

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

Acute myocardial infarction:

Hospitals performing PCI (PTCA/ Stenting)

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

Acute myocardial infarction:

Hospitals performing PCI (PTCA/ Stenting)

Open question 2: If costs differ so

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

Total cost (Euros)

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

Total cost (Euros)

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

For the new project, we then chose to look at

Exact reasons, expectations and DRG usage differ

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

What did we do?

Phase I (= session I today)

Phase II (= session II today)

Phase III (= this afternoon)

DRGs in Europe: Moving towards transparency, efficiency and quality in hospitals

EoC and related questions

Recommended for inclusion?

Recommended for inclusion?

Recommended for inclusion?

Recommended for inclusion?

Can you differentiate the

Recommended for inclusion?

Recommended for inclusion?

Recommended for inclusion?

Recommended for inclusion?

yes, but cannot identify disease stage

NO - CANNOT IDENTIFY DISEASE STAGE,

yes, however we should explicitly in- or exclude

We could have a clear picture of breast cancer.

Stages of the disease (TNM, IUCC ), grade of the disease (G1-G4)

Types of treatment: surgery, radiation, hormone immune and

NO - CANNOT IDENTIFY DISEASE STAGE,

yes, but a detailed definition is required

We could have a clear picture of colorectal cancer.

yes, but cannot identify disease stage

NO or maybe we think about redefining

NO or maybe we think about redefining

yes, but some difficulties

Stages of the cancer (TNM, IUCC, Dukes classification ), grade of

Types of treatment: surgery, radiation, chemotherapy

It is rather difficult to get a clear picture of diabetes

Reason for admission (e.g. hyperglycaemic or hypoglycaemic

Procedures related to the main diagnosis diabetes (e.g.