Avaliação de desempenho de unidade hospitalar por Diagnosis Related Groups (DRG) – casuística cirúrgica: um estudo de caso

Abstract

The difficulty and the methods to evaluate the performance of health organizations represent a huge challenge for hospital managers. The Diagnosis Related Groups (DRG) is a complete classification system, which aims to equip the hospital management enabling the measurement and evaluation of hospitals performance. We propose the use of DRG methodology to evaluate the performance of the surgical cases within a hospital unit. The theoretical foundation emphasized three themes: History and evolution of the DRG classification, the AP-DRG classification and performance evaluation and hospital management by DRG. The method used consisted of case study research with qualitative and quantitative exploratory and descriptive approach of data. The field of study was a General Hospital with 386 beds. The data were collected from the information contained in the hospital discharge document of each patient that underwent surgery in the period of one year (August 2013 to July 2014), and processed in the Grouper Software, initial instrument of the analysis, originating 213 different surgical DRGs. It was found that 16 DRGs accounted for 50% of all surgical cases, and 44 DRGs (20% of 213 sample surgical DRGs) accounted for 80% of all surgical cases of the institution. For comparison, we used data published annually by the Health Care System of Portugal. Of the 20 most frequent DRGs of the General Hospital, three presented a performance lower than the group of Portugal. However the performance of the other 17 DRGs of the sample was higher considering the hospital length of stay. The general objective proposed for the study, using the DRG to evaluate the performance of the surgical cases of the institution was achieved, as well as the objectives of developing the process of implementation of the DRG methodology, identification of impacts in the management of hospital services with the use of DRG, the comparison of the surgical series of the General Hospital performance with other hospitals using DRG and identification of improvement opportunities in processes of hospital care.