Abstract: Hospital information systems in China are improving and a casemix system for describing inpatient care is looking more feasible than previously. Implementing a casemix classification system for acute inpatient care in China could help to improve regional planning and hospital quality and efficiency. The purpose of this study was to evaluate the Australian DRG system as the basis for developing an acute inpatient casemix system appropriate for China. The applicability of the Australian AR-DRG system has been evaluated (in terms of homogeneity achieved and comparability of rank order) using inpatient data from Chengdu in Sichuan.Homogeneity achieved was good. The R2 value (the coefficient of multiple determination) was 0.12 for LOS and 0.17 for cost using untrimmed data and using (L3H3) trimmed data, R2 was 0.45 for LOS and 0.59 for cost. This explanatory power is comparable to other DRG classification systems although there are a few MDCs in which AR-DRGs exhibit poorer explanatory power.Rank order of groups was generally comparable. The AR-DRG system incorporates hierarchies of DRGs within groups of adjacent DRGs, within medical and surgical partitions and across all DRGs within each MDC. I have compared the ranking of DRGs based on average cost with the ranking assumed by the AR-DRG system, at the adjacent group level, within partitions and at the level of the MDC. I used the Spearman Rank Correlation coefficient to compare DRG order across partitions and whole MDCs. In general the cost relativities of the Chinese inpatient episodes grouped by the AR-DRG system correspond to the logical hierarchies assumed by the system. On this basis Chinese and Australian episodes of care within most of the MDCs appear to reflect the same broad pattern of resource consumption.Further research will be needed to determine where and how the grouping rules used in the AR-DRG system might need to be changed to more accurately reflect Chinese circumstances. For example the cost structures of Chinese health services are different from those in Australia. The Australian Refined DRGs (AR-DRGs) would provide a sound basis from which to develop a Chinese version of DRGs.
Thesis (Ph.D.) - La Trobe University, 2004.
Originally part of the Australasian Digital Theses (ADT) database.
Submission note: A thesis submitted in total fulfilment for the requirements for the degree of Doctor of Philosophy [to the School of Public Health], Faculty of Health Sciences, La Trobe University, Bundoora.
This thesis contained third party copyright material which has been removed. The thesis author retains all proprietary rights (such as copyright and patent rights) over all other content of this thesis, and has granted La Trobe University permission to reproduce and communicate this version of the thesis.