Diagnosis-related group refinement with diagnosis-and procedure-specific comorbidities and complications

Jean L. Freeman, Robert B. Fetter, Hayoung Park, Karen C. Schneider, Jeffrey L. Lichtenstein, John S. Hughes, William A. Bauman, Charles C. Duncan, Daniel H. Freeman, George R. Palmer

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Diagnosis-related groups have been revised through more refined uses of secondary diagnoses. Under the refined diagnosis-related groups, patients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a different level of utilization for a given principal diagnosis or surgical procedure. The refined system was evaluated with national data from the Medicare program. Estimates of hospital costs and utilization based on refined diagnosis-related groups were more precise than those based on unrefined diagnosis-related groups. This approach to diagnosis-related group refinement does not represent a radical departure from the current diagnosis- related group framework and does not require new data collection efforts. Moreover, a payment system based on the refined model is less affected by the ordering of the diagnoses than under the existing diagnosis-related group system. How the refined diagnosis-related group framework can accommodate future refinements at all levels of the classification scheme is also discussed.

Original languageEnglish (US)
Pages (from-to)806-827
Number of pages22
JournalMedical care
Issue number8
StatePublished - Aug 1995
Externally publishedYes


  • Comorbidity
  • Diagnosis-related group
  • Prospective Payment System
  • Severity of illness

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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