Impact of Semi-automated Proposal and Optimization of Diagnoses and Surgical Procedures for Precoding: a Randomized Controlled Trial

NCT04726202 | Completed

• 1 other identifier: Chir201902
• Study Type: observational
• Target: 1,200
• Locations: 1 country
• Sites: 1

Brief Summary

The hypothesis of present study is that the daily monitoring and optimization of DRG coding is associated with higher reimbursement. Therefore, the primary objective is to determine if the daily monitoring and optimization of DRG coding of individual cases leads to better proceeds per day.

Conditions

Diagnosis-Related Groups; Healthcare Common Procedure Coding System

Keywords

DRG; Diagnosis-Related Groups; ICD; reimbursement

Outcome Measures

Primary Outcomes (1)

• reimbursement per day at hospital

  total reimbursement per arm divided by the total stay of the patients in the arm in days

  8 months

Secondary Outcomes (5)

• Length of hospital stay

  8 months

• Total reimbursement per case

  8 months

• case mix index per case

  8 months

• Severity of perioperative complications

  8 months

• readmission rate

  8 months

Study Arms (2)

Control arm

standard procedure of coding at hospital

Other: Standard procedure

Precoding arm

Coding of the standard procedure will be reviewed and corrected

Other: precoding

Interventions

Standard procedure OTHER

Coding of cases follows the standard procedures established at the hospital

Control arm

precoding OTHER

Standard coding will be reviewed by dedicated physicians and corrected or extended if necessary. Coding will compared to the written OP report for consistency. Dedicated physician visits patients daily (in addition to routine visits). Dedicated physicians review discharge report and will make changes and additions. DRG coding will be adapted to results from visits and discharge report.

Precoding arm

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

patients undergoing inpatient surgery in the fields of General, Visceral, Endocrine or Transplantation Surgery

You may qualify if:

• patients undergoing surgery as inpatients (at least one night stay)
• treated at the Kantonsspital St. Gallen, St. Gallen site

You may not qualify if:

• surgery as outpatients
• surgery at the Rorschach and Flawil sites
• patients operated on by the Department of Surgery, but hospitalized at another department of the hospital

Sponsors & Collaborators

• Thomas Steffen: lead

Study Sites (1)

Department of Surgery, Cantonal Hospital of St. Gallen

Sankt Gallen, 9007, Switzerland

Location

Related Publications (8)

• Fillit H, Geldmacher DS, Welter RT, Maslow K, Fraser M. Optimizing coding and reimbursement to improve management of Alzheimer's disease and related dementias. J Am Geriatr Soc. 2002 Nov;50(11):1871-8. doi: 10.1046/j.1532-5415.2002.50519.x.

  PMID: 12410910 BACKGROUND

• Fetter RB, Freeman JL. Diagnosis related groups: product line management within hospitals. Acad Manage Rev. 1986 Jan;11(1):41-54.

  PMID: 10311457 BACKGROUND

• Fetter RB. Hospital payment based on diagnosis-related groups. J Soc Health Syst. 1992;3(4):4-15.

  PMID: 1288673 BACKGROUND

• Freeman JL, Fetter RB, Park H, Schneider KC, Lichtenstein JL, Hughes JS, Bauman WA, Duncan CC, Freeman DH Jr, Palmer GR. Diagnosis-related group refinement with diagnosis- and procedure-specific comorbidities and complications. Med Care. 1995 Aug;33(8):806-27. doi: 10.1097/00005650-199508000-00006.

  PMID: 7637403 BACKGROUND

• Hughes JS, Lichtenstein J, Fetter RB. Procedure codes: potential modifiers of diagnosis-related groups. Health Care Financ Rev. 1990 Fall;12(1):39-46.

  PMID: 10113461 BACKGROUND

• Geuss S, Jungmeister A, Baumgart A, Seelos R, Ockert S. [Prospective DRG coding : Improvement in cost-effectiveness and documentation quality of in-patient hospital care]. Chirurg. 2018 Feb;89(2):138-145. doi: 10.1007/s00104-017-0555-4. German.

  PMID: 29188352 BACKGROUND

• Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae.

  PMID: 15273542 BACKGROUND

• Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187-96. doi: 10.1097/SLA.0b013e3181b13ca2.

  PMID: 19638912 BACKGROUND

Related Links

• OnlineGrouper
• Common Terminology Criteria for Adverse Events (CTCAE)
• Federal Act on Data Protection (FADP)
• Human Research Act (HRA)
• Ordinance on Clinical Trials in Human Research (ClinO)

Study Officials

• Thomas Steffen, MD

  Cantonal Hospital of St. Gallen

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Deputy Head of Department

Study Record Dates

• First Submitted: January 22, 2021
• First Posted: January 27, 2021
• Study Start: June 1, 2019
• Primary Completion: January 1, 2020
• Study Completion: January 31, 2020
• Last Updated: August 4, 2021

Record last verified: 2021-08

Data Sharing

• IPD Sharing: Will not share

Locations

CH (1)