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

Study Overview
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Brief Summary
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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.

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

Conditions
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Diagnosis-Related Groups, Healthcare Common Procedure Coding System

Intervention / Treatment
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* Other: Standard procedure
* Other: precoding


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control arm<br>standard procedure of coding at hospital | Other: Standard procedure<br>* Coding of cases follows the standard procedures established at the hospital<br>|
| Precoding arm<br>Coding of the standard procedure will be reviewed and corrected | Other: precoding<br>* 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.<br>|

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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DRG, Diagnosis-Related Groups, ICD, reimbursement