Ryu, Kim, Lee, Kim, and Lim: A Study on the Severity Classification in the KDRG-KM (Korean Diagnosis-Related Groups - Korean Medicine)

Abstract

Backgrounds

Inpatient Classification System for Korean Medicine (KDRG-KM) was developed and has been applied for monitoring the costs of KM hospitals. Yet severity of patients’ condition is not applied in the KDRG-KM.

Objectives

This study aimed to develop the severity classification methods for KDRG-KM and assessed the explanation powers of severity adjusted KDRG-KM.

Methods

Clinical experts panel was organized based on the recommendations from 12 clinical societies of Korean Medicine. Two expert panel workshops were held to develop the severity classification options, and the Delphi survey was performed to measure CCL(Complexity and Comorbidity Level) scores. Explanation powers were calculated using the inpatient EDI claim data issued by hospitals and clinics in 2012.

Results

Two options for severity classification were deduced based on the severity classification principle in the domestic and foreign DRG systems. The option one is to classify severity groups using CCL and PCCL(Patient Clinical Complexity Level) scores, and the option two is to form a severity group with patients who belonged principal diagnosis-secondary diagnosis combinations which prolonged length of stay. All two options enhanced explanation powers less than 1%. For third option, patients who received certain treatments for severe conditions were grouped into severity group. The treatment expense of the severity group was significantly higher than that of other patients groups.

Conclusions

Applying the severity classifications using principal diagnosis and secondary diagnoses can advance the KDRG-KM for genuine KM hospitalization. More practically, including patients with procedures for severe conditions in a severity group needs to be considered.

Fig. 1
The Process of Severity Group Classification using KDRG’s PCCL Scores(Option 1)
†HIRA : Health Insurance Review & Assessment Service
jkm-38-3-185f1.gif
Fig. 2
The Process of Severity Group Classification using KM Principal & Secondary Diagnoses Combination (Option 2)
jkm-38-3-185f2.gif
Table 1
Definition of the CCL(Complications & Comorbidities Level) Scores & PCCL(Patient Clinical Complexity Level) Scores
CCL of diagnosis PCCL of patient
CCL = 0 : No CC effect PCCL = 0 : No CC effect
CCL = 1 : Minor CC PCCL = 1 : Minor CC
CCL = 2 : Moderate CC PCCL = 2 : Moderate CC
CCL = 3 : Severe CC PCCL = 3 : Severe CC
CCL = 4 : Catastrophic CC PCCL = 4 : Catastrophic CC
Table 2
The Results of Severity Group Classification Following the Option 1
KDRG-KM Disease group KDRG-KM Procedure group Age PCCL scores Severity scores No. of groups added
Genuine KM Hospitalization* G00-G99 Simple Tx group 0,1,2 1 1
3,4 2
Acupuncture-Moxibustion group 0 1 2
2 2
3,4 3
Acupuncture-Cupping group 0 1 1
2,3,4 2
Acupuncture-Moxibustion-Cupping group 0 1 2
2 2
3,4 3
I00-I52 Acupuncture-Moxibustion group 0 1 1
2,3,4 2
I60-I69 Simple Tx group 0 1 2
2 2
3,4 3
Acupuncture-Moxibustion group 0 1 1
2,3,4 2
Acupuncture-Cupping group 0 1 1
2,3,4 2
M00-36 Acupuncture-Moxibustion-Cupping group 0–64 0 1 1
2,3,4 2
S00-S99 Simple Tx group 0 1 1
2,3,4 2
Acupuncture-Moxibustion group 0 1 2
2 2
3,4 3
Acupuncture-Moxibustion-Cupping group 0–79 0 1 1
2,3,4 2
Sub-total 16
Co-treatment Hospitalization** C00-99 Simple Tx group 0 1 2
2 2
3,4 3
Acupuncture-Moxibustion group 0 1 1
2,3,4 2
Acupuncture-Cupping group 0,2 1 1
3,4 2
Acupuncture-Moxibustion-Cupping group 0,2 1 1
3,4 2
G00-G99 Simple Tx group 0,2 1 1
3,4 2
Acupuncture-Cupping group 0,2 1 1
3,4 2
Acupuncture-Moxibustion-Cupping group 0,2 1 1
3,4 2
J00-J22 Simple Tx group 0 1 1
2,3,4 2
J30-J99 Simple Tx group 0 1 1
2,3,4 2
S00-S99 Simple Tx group 0–64 0 1 1
2,3,4 2
Acupuncture-Cupping group 0 1 1
2,3,4 2
U60-79 Acupuncture-Moxibustion-Cupping group 0 1 1
2,3,4 2
Sub-total 13
Total 29

* Genuine KM Hospitalization: Korean Medicine (KM) hospital admission except Co-treatment Hospitalization

** Co-treatment Hospitalization: KM treatment claim during Western Medicine hospitalization

Table 3
The Numbers of KM Diseases by CCL Scores
U-code CCL 0 CCL 1 CCL 2
KM Qi, Blood, Viscera and Bowels Diseases & Others (한의기혈장부병증 및 기타한의병명) 92 19 17
KM diseases of external contraction (한의외감병증) 57 8 2
KM Sasang Constitutional diseases (한의사상체질병증) 18 0 0
KM Disease Names (한의 병명) 58 12 18
Total 225 39 37
Table 4
The Results of Severity Group Classification Following the Option 2
KDRG-KM
Disease group
KDRG-KM
Procedure group
Age No. of PCCL scores
Genuine KM Hospitalization 11 (I60–I69) Simple Tx group 1
Acupuncture-Moxibustion group 1
Acupuncture-Moxibustion-Cupping group 1
Acupuncture-Cupping group 1
17 (M40–M54) Simple Tx group 0–64 1
Acupuncture-Moxibustion-Cupping group 0–64 1
65 & over 1
Acupuncture-Cupping group 0–64 1
21 (R00–R99) Simple Tx group 0–79 1
22 (S00–S99) Simple Tx group 1
Acupuncture-Moxibustion-Cupping group 0–79 1
Acupuncture-Cupping group 0–79 1
Sub-total 12
Co-treatment Hospitalization 08 (G00–G99) Acupuncture-Cupping group 1
11 (I60–I69) Simple Tx group 1
Acupuncture-Moxibustion group 1
17 (M40–M54) Simple Tx group 0–64 1
Sub-total 4
Total 16

* Procedure groups in the shaded cells are also occurred in the results with Option 1

Table 5
Explanation Powers of Each Type of KDRG-KM
Total number of claims submitted Number of claims excluding outliers (% of total) Number of claims analyzed Explanation power (R2) Numbers of patient groups
KDRG-KM 943,842 35,987(3.81) 907,855 66.47 233
KDRG-KM applying Severity classification Option 1 66.50 262
KDRG-KM applying Severity classification Option 2 66.65 248

* R2 scores were calculated from Regression analysis using General Linear Model.

Table 6
Comparisons of Severity Treatment Group and the Other Group
No. of claims Treatment expenses (Korean Won) p
Mean SD
All KM hospitalization Severity Group 3,113 1,548,960 1,174,045 < 0.0001
The Other group 940,729 195,501 321,918
Total 943,842 199,965 337,426
Genuine KM hospitalization Severity Group 3,087 1,560,273 1,171,973 < 0.0001
The Other group 162,880 710,402 515,070
Total 165,967 726,210 546,889

† Severity treatments include L-tube feeding, urinary catheterization, oxygen driven nebulization, and enema.

* T-test was applied.

참고문헌

1 Health Insurance Review & Assessment Service. Guidebook for KDRG-KM (PDF format). 2017.


2 Kim DS, Ryu JS, Lee BW, Lim BM. Assessment of Validity of Inpatient Classification System in Korean Medicine (KDRG-KM). J Korean Med. 2016; 37:3. 112–122. http://dx.doi.org/10.13048/jkm.16039
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7 Health Insurance Review & Assessment Service. KDRG classification book; version 3.5. 2014.


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9 Gu SJ. Analysis of specialized diseases in pre-post pilot program for Korean Medicine special hospital. Hanbang Jeonmoonbyeongwon Sibeomsaup Silsi Jeonhoo Jeonmoonjilhwan Uiryoyiyong Boonseok. Master dissertation. Seoul: Yonsei University;2009.


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