Suitability of casemix classification for output funding of blood services in Victoria

Abstract

Objective To study the suitability of diagnosis‐related groups (DRGs) to quantify blood use in order to fund hospitals directly for fresh blood components. Design (i) Retrospective empirical analysis of hospital inpatient separation data, matching DAG classification with blood usage. (ii) Prediction of blood usage based on actual DRGs and comparison with actual blood products issued from the blood service. Setting Eight large public hospitals, April 1994 ‐ March 1995, the Department of Human Services and the Australian Red Cross Blood Service in Victoria, 1994‐1997. Main outcome measures Requirement for transfusion according to DAG; quantity of blood or blood products transfused; and statistical reliability of measuring blood component usage by DAG. Results A match between patient records and transfusion records for 287117 patient separations showed that the patients had received 51 115 units of red cells, 30 451 units of platelet concentrates, 9043 units of fresh frozen plasma and 1273 units of cryoprecipitate. Ten per cent of DRGs (527) accounted for over 70% of blood product usage. The numbers of DRGs in which blood products were used for at least 30 separations (with a relative SEM [for units of blood used per separations using blood] of up to 20% at a 95% confidence level) were 56 for red cells, 8 for platelets and 4 for fresh frozen plasma. Estimates of red cell usage calculated from actual DRGs for three consecutive years (1994‐1997) showed that DRGs predicted aggregate issues of red cells by the Red Cross Blood Service (ratio of actual red cells issued to red cell usage estimates were 1.036 for 1994‐95, 0.994 for 1995‐96, and 1.021 for 1996‐97, respectively). Conclusion DRGs are moderately good predictors of blood product usage, and could be used to allocate funds for blood products to hospitals instead of to the blood service. However, DAG data are not designed to manage blood issue policies, because DRGs do not represent single diagnoses or procedures and some are surrogate descriptions of procedures.

Assessment of the urgency and deferability of transfusion to inform emergency blood planning and triage: the Bloodhound prospective audit of red blood cell use

“…At least half of RBCs were issued for medical anemia, including a high proportion (34%) for hematooncology patients. Other evidence confirms the high transfusion requirements of this group 16 . The average RBC transfusion requirement for an adult patient undergoing chemotherapy for acute myeloid leukemia is approximately 30 units, with over half of products administered during consolidation 17 .…”

“…Our results are consistent with those of European audits 9‐12 that demonstrated recent declining allogeneic RBC use in surgery, offset by an increased proportion of transfusion for medical anemia. Local historical data using diagnosis‐related groups to determine clinical areas of hospital blood use also supports the finding of high RBC use for nonsurgical indications, particularly hematooncology‐related transfusion 16 . Other major areas where opportunities to reduce or defer use are limited and include acute bleeding and urgent surgery.…”

Transfusion practice in Helsinki University Central Hospital: an analysis of diagnosis‐related groups (DRG)

“…Frequently used indicators in these studies are the proportion of transfused patients and mean transfusion rates in distinct diagnostic operations. In Australia, a DRG casemix classification has been suggested as a basis for output funding of blood services (Hetzel, 1998; Whyte & Brook, 1998). By using advanced software, it has been possible to produce reports that describe very recent transfusion policies.…”

Audit on the usage of plasma derived/recombinant coagulation factor concentrates at a German University Hospital

“…Whyte et al. (1998) included cryoprecipitate into their analysis [18], in which they examined the suitability of DRGs to quantify the usage of blood components in order to distribute funds for transfusion costs. In their study though, they did not present figures regarding the diagnosis of patients substituted with cryoprecipitate.…”