Volume 20, Issue 12 (March 2023)                   Nursing and Midwifery Journal 2023, 20(12): 984-991 | Back to browse issues page


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Jebraeily M, Khorrami F, Touraj S. THE PROBLEMS OF DOCUMENTING MEDICAL RECORDS IN THE IMPLEMENTATION OF A PAYMENT SYSTEM BASED ON DIAGNOSIS-RELATED GROUPS (DRG): A QUALITATIVE RESEARCH. Nursing and Midwifery Journal 2023; 20 (12) :984-991
URL: http://unmf.umsu.ac.ir/article-1-4817-en.html
1- Associate Professor of Health Information Management, Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran , jabraily@gmail.com
2- Assistant Professor of Health Information Management, Department of Health Information Technology, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
3- Masters Student of Health Information Technology, Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran (Corresponding Author)
Abstract:   (656 Views)
Background & Aims: The payment system based on diagnosis-related groups was created to control the costs of health care services, increase efficiency in inpatient care, and improve transparency in hospital activities. The success of this system depends on complete and accurate documentation of medical records and correct coding of diagnoses and procedures. This research aimed to determine the problems of documenting medical records to implement a payment system based on DRGs.
Materials & Methods: This research was a qualitative study that was conducted using the semi-structured interview method in 2022. The research population included experts in health information management and health economics at Urmia University of Medical Sciences, who were selected purposefully. Data analysis was done through content analysis using ATLAS.ti software.
Results: From the point of view of the interviewees, the most important problems of documenting medical records in the implementation of DRGs, included the lack of clinical documentation guidelines, the lack of necessary information elements, the lack of accurate evaluation of the quality of documentation, and coding, the lack of continuous training courses, the incompleteness of documentation, and the lack of sufficient interaction between doctors and coders were in the hospital.
Conclusion: The results of this research showed that some essential variables for implementing the DRGs system are not defined separately and clearly in the medical records and the hospital information system, and the quality of the documentation and coding is not accurate and complete. Therefore, it seems necessary to consider separate information elements for the main diagnosis, the main action, and the comorbidity and complications in the standard medical record forms.
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Type of Study: Qualitative | Subject: بهداشت

References
1. Movassaghi H, Chokhachi Zade Moghaddam Y. World health Organization Legal Problems and Difficulties and Challenges Forward to. Sociol Stud 2019;12(44):7-25. [Google Scholar]
2. Malmmose M, Lydersen JP. From centralized DRG costing to decentralized TDABC-assessing the feasibility of hospital cost accounting for decision-making in Denmark. BMC Health Serv Res 2021;21(1):1-5. [DOI:10.1186/s12913-021-06807-4] [PMID] [PMCID]
3. Roberts MJ, Hsiao W, Berman P, Reich MR. Getting health reform right: a guide to improving performance and equity. New York: Oxford University Press; 2004. [URL]
4. Langenbrunner J, Cashin C, O'Dougherty S. Designing and implementing health care provider payment systems: how-to manuals: World Bank Publications; 2009. [DOI:10.1596/978-0-8213-7815-1]
5. Goldfield N. The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital. Qual Manag Health Care 2010;19(1):3-16. [DOI:10.1097/QMH.0b013e3181ccbcc3] [PMID]
6. Busato A, von Below G. The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective. Health Res Policy Syst 2010;8(1):1-6. [DOI:10.1186/1478-4505-8-31] [PMID] [PMCID]
7. Or Z. Implementation of DRG Payment in France: Issues and recent developments. Health Pol Res 2014;117(2):146-50. [DOI:10.1016/j.healthpol.2014.05.006] [PMID]
8. O'Reilly J, Busse R, Häkkinen U, Or Z, Street A, Wiley M. Paying for hospital care: the experience with implementing activity-based funding in five European countries. Health Econ Policy Law 2012;7(1):73-101. [DOI:10.1017/S1744133111000314] [PMID]
9. Vogl M. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany. Health Econ Rev 2012;2(1):1-2. [DOI:10.1186/2191-1991-2-15] [PMID] [PMCID]
10. Annear PL, Kwon S, Lorenzoni L, Duckett S, Huntington D, Langenbrunner JC, Murakami Y, Shon C, Xu K. Pathways to DRG-based hospital payment systems in Japan, Korea, and Thailand. Health Policy 2018;122(7):707-13. [DOI:10.1016/j.healthpol.2018.04.013] [PMID]
11. Goldfield N. The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital. Qual Manag Health Care 2010;19(1):3-16. [DOI:10.1097/QMH.0b013e3181ccbcc3] [PMID]
12. Serdén L, Lindqvist R, Rosén M. Have DRG-based prospective payment systems influenced the number of secondary diagnoses in health care administrative data?. Health Policy 2003;65(2):101-7. [DOI:10.1016/S0168-8510(02)00208-7] [PMID]
13. Camilleri C, Jofre-Bonet M, Serra-Sastre V. The suitability of a DRG casemix system in the Maltese hospital setting. Health Policy 2018;122(11):1183-9. [DOI:10.1016/j.healthpol.2018.08.002] [PMID]
14. Choi JW, Kim SJ, Park HK, Jang SI, Kim TH, Park EC. Effects of a mandatory DRG payment system in South Korea: analysis of multi-year nationwide hospital claims data. BMC Health Serv Res 2019;19(1):1-9. [DOI:10.1186/s12913-019-4650-8] [PMID] [PMCID]
15. Busse R, Geissler A, Aaviksoo A, Cots F, Häkkinen U, Kobel C, Mateus C, Or Z, O'Reilly J, Serdén L, Street A. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? Br Med J 2013;346. [DOI:10.1136/bmj.f3197] [PMID]
16. Chin N, Perera P, Roberts A, Nagappan R. Review of medical discharge summaries and medical documentation in a metropolitan hospital: impact on diagnostic‐related groups and Weighted Inlier Equivalent Separation. Int Med J 2013;43(7):767-71. [DOI:10.1111/imj.12084] [PMID]
17. Ballentine NH. Coding and documentation: Medicare severity diagnosis‐related groups and present‐on‐admission documentation. J Hosp Med 2009;4(2):124-30. [DOI:10.1002/jhm.416] [PMID]
18. Gluckman TJ, Spinelli KJ, Wang M, Yazdani A, Grunkemeier G, Bradley SM, Wasfy JH, Goyal A, Oseran A, Maddox KE. Trends in diagnosis related groups for inpatient admissions and associated changes in payment from 2012 to 2016. JAMA Netw Open 2020;3(12):e2028470-. [DOI:10.1001/jamanetworkopen.2020.28470] [PMID]
19. Rosenstein AH, O'Daniel M, White S, Taylor K. Medicare's value-based payment initiatives: impact on and implications for improving physician documentation and coding. Am J Med Qual 2009;24(3):250-8. [DOI:10.1177/1062860609332511] [PMID]
20. Ghaffari S, Doran C, Wilson A, Aisbett C. Trialling diagnosis-related groups classification in the Iranian health system: a case study examining the feasibility of introducing casemix. East Mediterr Health J 2010;16(5):460-6. [DOI:10.26719/2010.16.5.460] [PMID]
21. Ghaffari S, Jackson TJ, Doran CM, Wilson A, Aisbett C. Describing Iranian hospital activity using Australian refined DRGs: A case study of the Iranian social security organisation. Health Policy 2008;87(1):63-71. [DOI:10.1016/j.healthpol.2007.09.014] [PMID]
22. Cheng P, Gilchrist A, Robinson KM, Paul L. The risk and consequences of clinical miscoding due to inadequate medical documentation: a case study of the impact on health services funding. Health Inf Manag J 2009;38(1):35-46. [DOI:10.1177/183335830903800105] [PMID]
23. Zafirah S, Nur AM, Puteh SEW, Aljunid SM. Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia. BMC Health Serv Res 2018;18(1):1-11. [DOI:10.1186/s12913-018-2843-1] [PMID] [PMCID]

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