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Diagnosis-related groups (DRGs) are a classification of hospital case types into groups expected to have similar hospital resource use. The groupings are based on diagnoses (using ICD), procedures, age, sex, and the presence of complications or comorbidities (definition from the Agency for Healthcare Research and Quality).
Diagnosis-related groups are a system for classifying patient care by relating common characteristics such as diagnosis , treatment and age, to an expected consumption of hospital resources and length of stay. They form the cornerstone of the prospective payment system (definition based on Medline, 1997; Decision Group, 1999).
The DRGs work by grouping the 10,000+ ICD codes into a more manageable number of meaningful patient categories (close to 500 in 2003). Patients within each category are similar clinically and in terms of resource use (the DRG grouper uses administrative data to group patients).
I.e., in 1991, the top 10 DRGs overall are: normal newborn, vaginal delivery, heart failure, psychoses, cesarean section, neonate with significant problems, angina pectoris, specific cerebrovascular disorders, pneumonia, and hip/knee replacement. They comprise nearly 30 percent of all hospital discharges.
Created by Robert Barclay Fetter in the Yale University with the material support of the former Health Care Financing Administration (HCFA), nowadays the Centers for Medicare and Medicaid Services (CMS), in the United States Department of Health and Human Services.
In 1983 it was adopted officially by Medicare to pay hospitals for healthcare based on diagnosis, age, gender, and complications.
The history, design and classification rules of the DRG system, as well as its application on patient discharge data and updating procedures, are presented in the HCFA DRG Definitions Manual (Also known as the Medicare DRG Definitions Manual and the Grouper Manual). Generally appears in October of every year a new version. In 2002 appeared the 20.0 version.
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