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

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.

Study Overview

• Status: Completed
• Conditions: Diagnosis-Related Groups; Healthcare Common Procedure Coding System
• Intervention / Treatment: Other: Standard procedure; Other: precoding

• Study Type: Observational
• Enrollment (Actual): 1200

Contacts and Locations

Study Locations

• Switzerland
  • St. Gallen, Switzerland, 9007
    • Department of surgery, Cantonal hospital of St. Gallen

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

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

Description

Inclusion Criteria:

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

Exclusion Criteria:

• 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

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Control arm; standard procedure of coding at hospital	Other: Standard procedure; Coding of cases follows the standard procedures established at the hospital
Precoding arm; Coding of the standard procedure will be reviewed and corrected	Other: precoding; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of hospital stay	length of hopital stay in full days including entry and discharge day	8 months
Total reimbursement per case	reimbursement in Swiss Francs per case	8 months
case mix index per case	Financial department will provide the cost weight/case mix index per case	8 months
Severity of perioperative complications	complications during hospitalisation will be graded according to the Clavian-Dindo scale. In case of multiple complications the highest grade will be taken.	8 months
readmission rate	Rate of case related readmissions	8 months

Collaborators and Investigators

• Sponsor: Thomas Steffen
• Investigators: Principal Investigator: Thomas Steffen, MD, Cantonal Hospital St. Gallen

Publications and helpful links

General Publications

• 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.
• 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.
• 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.
• Fetter RB, Freeman JL. Diagnosis related groups: product line management within hospitals. Acad Manage Rev. 1986 Jan;11(1):41-54.
• Fetter RB. Hospital payment based on diagnosis-related groups. J Soc Health Syst. 1992;3(4):4-15.
• 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.
• Hughes JS, Lichtenstein J, Fetter RB. Procedure codes: potential modifiers of diagnosis-related groups. Health Care Financ Rev. 1990 Fall;12(1):39-46.
• 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.

Helpful Links

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

Study record dates

Study Major Dates

• Study Start (ACTUAL): June 1, 2019
• Primary Completion (ACTUAL): January 1, 2020
• Study Completion (ACTUAL): January 31, 2020

Study Registration Dates

• First Submitted: January 22, 2021
• First Submitted That Met QC Criteria: January 22, 2021
• First Posted (ACTUAL): January 27, 2021

Study Record Updates

• Last Update Posted (ACTUAL): August 4, 2021
• Last Update Submitted That Met QC Criteria: August 3, 2021
• Last Verified: August 1, 2021

More Information

Terms related to this study

• Keywords: ICD; DRG; Diagnosis-Related Groups; reimbursement
• Additional Relevant MeSH Terms: Pathologic Processes; Disease
• Other Study ID Numbers: Chir201902

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No