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Research
An Evaluation of the Patient Clinical Complexity Level (PCCL) Method for the Complexity Adjustment in the Korean Diagnosis-Related Groups (KDRG)
Sukil Kim
Catholic University of Korea College of Medicine: Catholic University of Korea School of Medicine
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objective
To evaluate the performance of the Patient Clinical Complexity Level (PCCL) mechanism, which is the patient level complexity adjustment factor within the Korean Diagnosis-Related Groups (KDRG) patient classification system, for explaining the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs).
Methods
We used the inpatient claims data from a public hospital in Korea from January 1, 2017 to June 30, 2019, with 18,846 claims and 138 Age Adjacent Diagnosis-related groups (AADRGs). The differences in the total average payment between the four PCCL levels for each AADRG was tested using ANOVA and Duncan’s post-hoc test. The three patterns of the differences with R-squared were: the PCCL reflected the complexity well (Valid); the average payment of PCCL 2, 3, 4 was greater than PCCL 0 (Partially Valid); the PCCL did not reflect the complexity (Not Valid).
Results
There were 9 (6.52%), 26 (18.84%), and 103 (74.64%) ADRGs included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average R-squared in VALID, PARTIALLY VALID, and NOT VALID was 32.18%, 40.81%, and 35.41% respectively, with the average R-squared for all patterns of 36.21%.
Conclusions
Adjusting using PCCL in the KDRG classification system exhibited low performance to explain the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs). As the KDRG classification system is used for reimbursement under the New DRG-based PPS pilot project with plans for expansion, there should be an overall review of the validity of the complexity and rationality of using the KDRG classification system.
Keywords
Diagnosis-Related Groups, Inpatient, Risk Adjustment, Prospective Payment System
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Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Sep, 2020
No community comments so far
Reviewer #3 agreed
On 17 Jan, 2021
Review #2 received
Received 12 Dec, 2020
Review #1 received
Received 06 Dec, 2020
Reviewer #2 agreed
On 15 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Reviewers invited
Invitations sent on 02 Oct, 2020
Editor assigned
On 17 Sep, 2020
First submitted
On 16 Sep, 2020
Submission checks complete
On 16 Sep, 2020
Editor invited
On 16 Sep, 2020
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
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This preprint is under consideration at Health Research Policy and Systems. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
An Evaluation of the Patient Clinical Complexity Level (PCCL) Method for the Complexity Adjustment in the Korean Diagnosis-Related Groups (KDRG)
Sukil Kim
Catholic University of Korea College of Medicine: Catholic University of Korea School of Medicine
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Sep, 2020
No community comments so far
Reviewer #3 agreed
On 17 Jan, 2021
Review #2 received
Received 12 Dec, 2020
Review #1 received
Received 06 Dec, 2020
Reviewer #2 agreed
On 15 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Reviewers invited
Invitations sent on 02 Oct, 2020
Editor assigned
On 17 Sep, 2020
First submitted
On 16 Sep, 2020
Submission checks complete
On 16 Sep, 2020
Editor invited
On 16 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objective
To evaluate the performance of the Patient Clinical Complexity Level (PCCL) mechanism, which is the patient level complexity adjustment factor within the Korean Diagnosis-Related Groups (KDRG) patient classification system, for explaining the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs).
Methods
We used the inpatient claims data from a public hospital in Korea from January 1, 2017 to June 30, 2019, with 18,846 claims and 138 Age Adjacent Diagnosis-related groups (AADRGs). The differences in the total average payment between the four PCCL levels for each AADRG was tested using ANOVA and Duncan’s post-hoc test. The three patterns of the differences with R-squared were: the PCCL reflected the complexity well (Valid); the average payment of PCCL 2, 3, 4 was greater than PCCL 0 (Partially Valid); the PCCL did not reflect the complexity (Not Valid).
Results
There were 9 (6.52%), 26 (18.84%), and 103 (74.64%) ADRGs included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average R-squared in VALID, PARTIALLY VALID, and NOT VALID was 32.18%, 40.81%, and 35.41% respectively, with the average R-squared for all patterns of 36.21%.
Conclusions
Adjusting using PCCL in the KDRG classification system exhibited low performance to explain the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs). As the KDRG classification system is used for reimbursement under the New DRG-based PPS pilot project with plans for expansion, there should be an overall review of the validity of the complexity and rationality of using the KDRG classification system.
Figure 1