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Open Access Research article

DRG coding practice: a nationwide hospital survey in Thailand

Krit Pongpirul12*, Damian G Walker2, Hafizur Rahman2 and Courtland Robinson2

Author Affiliations

1 Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

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BMC Health Services Research 2011, 11:290  doi:10.1186/1472-6963-11-290

Published: 31 October 2011

Abstract

Background

Diagnosis Related Group (DRG) payment is preferred by healthcare reform in various countries but its implementation in resource-limited countries has not been fully explored.

Objectives

This study was aimed (1) to compare the characteristics of hospitals in Thailand that were audited with those that were not and (2) to develop a simplified scale to measure hospital coding practice.

Methods

A questionnaire survey was conducted of 920 hospitals in the Summary and Coding Audit Database (SCAD hospitals, all of which were audited in 2008 because of suspicious reports of possible DRG miscoding); the questionnaire also included 390 non-SCAD hospitals. The questionnaire asked about general demographics of the hospitals, hospital coding structure and process, and also included a set of 63 opinion-oriented items on the current hospital coding practice. Descriptive statistics and exploratory factor analysis (EFA) were used for data analysis.

Results

SCAD and Non-SCAD hospitals were different in many aspects, especially the number of medical statisticians, experience of medical statisticians and physicians, as well as number of certified coders. Factor analysis revealed a simplified 3-factor, 20-item model to assess hospital coding practice and classify hospital intention.

Conclusion

Hospital providers should not be assumed capable of producing high quality DRG codes, especially in resource-limited settings.