A Study on the Severity Classification in the KDRG-KM (Korean Diagnosis-Related Groups - Korean Medicine)

Jiseon Ryu; Dongsu Kim; Byungwook Lee; Changhoon Kim; Byungmook Lim; Ryu, Jiseon; Kim, Dongsu; Lee, Byungwook; Kim, Changhoon; Lim, Byungmook

doi:10.13048/jkm.17035

JKM > Volume 38(3); 2017 > Article

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

Original Article

The Journal of Korean Medicine 2017; 38(3): 185-196.

Published online: September 30, 2017

DOI: https://doi.org/10.13048/jkm.17035

A Study on the Severity Classification in the KDRG-KM (Korean Diagnosis-Related Groups - Korean Medicine)

Jiseon Ryu¹, Dongsu Kim², Byungwook Lee³, Changhoon Kim⁴, Byungmook Lim⁵

¹Research Institute for Korean Medicine, Pusan National University

²Korean Medicine Standards Center, Korea Institute of Oriental Medicine

³College of Korean Medicine, Dongguk University

⁴Department of Preventive Medicine, School of Medicine, Pusan National University

⁵Division of Humanities and Social Medicine, School of Korean Medicine, Pusan National University

Correspondence to：임병묵(Byungmook Lim) 부산대학교 한의학전문대학원 인문사회의학부 Tel：+82-51-510-8453, Fax：+82-51-510-8446, E-mail : limb@pusan.ac.kr

Received September 6, 2017 Revised September 22, 2017 Accepted September 26, 2017

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.

Keywords: KDRG-KM, Diagnosis-Related Groups, patient classification system, Korean Medicine, severity classification, CCL

Fig. 1

The Process of Severity Group Classification using KDRG’s PCCL Scores(Option 1)

†HIRA : Health Insurance Review & Assessment Service

Fig. 2

The Process of Severity Group Classification using KM Principal & Secondary Diagnoses Combination (Option 2)

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
		Simple Tx group		3,4	2	1
		Acupuncture-Moxibustion group		0	1	2
				2	2
				3,4	3
		Acupuncture-Cupping group		0	1	1
		Acupuncture-Cupping group		2,3,4	2	1
		Acupuncture-Moxibustion-Cupping group		0	1	2
				2	2
				3,4	3
	I00-I52	Acupuncture-Moxibustion group		0	1	1
	I00-I52	Acupuncture-Moxibustion group		2,3,4	2	1
	I60-I69	Simple Tx group		0	1	2
				2	2
				3,4	3
		Acupuncture-Moxibustion group		0	1	1
		Acupuncture-Moxibustion group		2,3,4	2	1
		Acupuncture-Cupping group		0	1	1
		Acupuncture-Cupping group		2,3,4	2	1
	M00-36	Acupuncture-Moxibustion-Cupping group	0–64	0	1	1
	M00-36	Acupuncture-Moxibustion-Cupping group	0–64	2,3,4	2	1
	S00-S99	Simple Tx group		0	1	1
		Simple Tx group		2,3,4	2	1
		Acupuncture-Moxibustion group		0	1	2
				2	2
				3,4	3
		Acupuncture-Moxibustion-Cupping group	0–79	0	1	1
		Acupuncture-Moxibustion-Cupping group	0–79	2,3,4	2	1
	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
		Acupuncture-Moxibustion group		2,3,4	2	1
		Acupuncture-Cupping group		0,2	1	1
		Acupuncture-Cupping group		3,4	2	1
		Acupuncture-Moxibustion-Cupping group		0,2	1	1
		Acupuncture-Moxibustion-Cupping group		3,4	2	1
	G00-G99	Simple Tx group		0,2	1	1
		Simple Tx group		3,4	2	1
		Acupuncture-Cupping group		0,2	1	1
		Acupuncture-Cupping group		3,4	2	1
		Acupuncture-Moxibustion-Cupping group		0,2	1	1
		Acupuncture-Moxibustion-Cupping group		3,4	2	1
	J00-J22	Simple Tx group		0	1	1
	J00-J22	Simple Tx group		2,3,4	2	1
	J30-J99	Simple Tx group		0	1	1
	J30-J99	Simple Tx group		2,3,4	2	1
	S00-S99	Simple Tx group	0–64	0	1	1
		Simple Tx group	0–64	2,3,4	2	1
		Acupuncture-Cupping group		0	1	1
		Acupuncture-Cupping group		2,3,4	2	1
	U60-79	Acupuncture-Moxibustion-Cupping group		0	1	1
	U60-79	Acupuncture-Moxibustion-Cupping group		2,3,4	2	1
	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
		Acupuncture-Moxibustion-Cupping group	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
	11 (I60–I69)	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
		No. of claims	Mean	SD	p
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

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