Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
COVID-19 Pandemisinin Hastanelerin Vaka Karma İndeksine Etkisinin Değerlendirilmesi: Tanımlayıcı Bir Araştırma
Evaluation of the Impact of the COVID-19 Pandemic on the Case Mixed Index of Hospitals: A Descriptive Study
Emine ÇETİN ASLANa, Mustafa ORHANa
aİzmir Bakırçay Üniversitesi Sağlık Bilimleri Fakültesi, Sağlık Yönetimi Bölümü, İzmir, Türkiye
Turkiye Klinikleri J Health Sci. 2022;7(3):888-98
doi: 10.5336/healthsci.2021-87432
Article Language: TR
Full Text
ÖZET
 Amaç: Araştırmanın amacı, koronavirüs hastalığı 2019 [coronavirus disease 2019 (COVID-19)] pandemisi döneminde, sağlık kurumlarının sunmuş oldukları sağlık hizmet üretim hacminin değişip değişmediğini araştırmaktır. Ayrıca COVID-19 hastalarının vaka karma indeksinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışma, retrospektif, kesitsel ve tanımlayıcı bir araştırmadır. Araştırma, Sağlık Bakanlığına bağlı bir B grubu hastanede yapılmış olup, veriler 2019 ve 2020 yıllarını kapsamaktadır. Sağlık hizmeti üretimindeki değişim tedavi edilen hasta sayısı, üretilen toplam teşhis ilişkili gruplar bağıl değeri ve vaka karma indeksi ile ölçülmüştür. Vaka karma indeksi, belli bir dönemdeki toplam bağıl değerlerin aynı dönemdeki toplam hasta sayısına bölünmesiyle hesaplanmıştır. Bulgular: Hastanede, 2019 yılında 15.944, ve 2020 yılında, 1.343'ü COVID-19 olmak üzere, toplam 10.697 hasta tedavi görmüştür. Dolayısıyla hasta başvurularında yaklaşık 1/3'lük bir azalış gerçekleşmiştir. Pandemi döneminde hastanede bakılan hasta sayısı ve üretilen toplam bağıl değer düşmüş, buna karşın vaka karma indeksi yükselmiştir. Hastanenin vaka karma indeksi 2019 yılında 0,90, 2020 yılında 0,97 ve COVID-19 hastalarında 0,99 bulunmuştur. COVID-19 hastalarının vaka karma indeksi dönemlere göre farklılık göstermiştir. Sonuç: Pandemi süreci hastanede üretilen sağlık hizmeti miktarının azalmasına neden olmuştur. Ancak vaka karma indeksi artmıştır. Vaka karma indeksindeki artışta, COVID-19 hastalarının teşhis ilişkili gruplar bağıl değerlerinin pandemi öncesi dönemde bakılan hastalarının bağıl değerlerinden yüksek olmasının yanında, düşük bağıl değerli vaka başvurularındaki azalışın ortak etkisinden kaynaklandığı sonucuna varılmıştır.

Anahtar Kelimeler: COVID-19; pandemi; teşhis ilişkili gruplar; vaka karma indeksi
ABSTRACT
 Objective: The aim of the research is to investigate whether the volume of health care production offered by health institutions has changed during the coronavirus disease 2019 [coronavirus disease 2019 (COVID-19)] pandemic. In addition, it was aimed to determine the case mix index of COVID-19 patients. Material and Methods: The study is a retrospective, cross-sectional and descriptive study. The research was conducted in a group B hospital affiliated to the Ministry of Health, and the data cover the years 2019 and 2020. Change in healthcare production was measured by the number of patients treated, the relative value of total diagnosis-related groups produced, and the case mix index. The case mix index was calculated by dividing the total relative values in a given period by the total number of patients in the same period. Results: 15,944 patients were treated at the hospital in 2019, and a total of 10,697 patients in 2020 were treated, of which 1,343 were COVID-19. Therefore, there has been a decrease of approximately 1/3 in patient admissions. During the pandemic period, the number of patients cared for in the hospital and the total relative value produced decreased, but the case mix index increased. The hospital's case mix index was 0.90 in 2019, 0.97 in 2020, and 0.99 for COVID-19 patients. The case mix index of COVID-19 patients differed according to the periods. Conclusion: The pandemic process has led to a decrease in the amount of healthcare services produced in the hospital. However, the case mix index increased. It has been concluded that the increase in the case mix index is due to the common effect of the decrease in case admissions with low relative values, as well as the relative values of the diagnosisrelated groups of COVID-19 patients being higher than the relative values of the patients cared for in the pre-pandemic period.

Keywords: COVID-19; pandemic; diagnosis-related groups; case mix index
REFERENCES:
  1. Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD. Case mix definition by diagnosis-related groups. Med Care. 1980 Feb;18(2 Suppl):iii, 1-53. [PubMed] 
  2. Aral A. Sağlıkta Yeni Dönem DRG (TİG). 1. Baskı. Ankara: Sade Yayıncılık ve Matbaacılık; 2014.
  3. Tedavi Hizmetleri Genel Müdürlüğü [İnternet]. © 2022 T.C. Sağlık Bakanlığı. [Erişim tarihi: 20 Nisan 2022]. Hastane Rolleri, 2009 Erişim linki: [Link] 
  4. WHO [Internet]. © 2022 WHO. [Cited: May 22, 2021]. Archived: WHO Timeline-COVID-19 2020 Available from: [Link] 
  5. Khullar D, Bond AM, Schpero WL. COVID-19 and the Financial Health of US Hospitals. JAMA. 2020;323(21):2127-8. [Crossref]  [PubMed] 
  6. Mistichelli J. Diagnosis related groups (DRGs) and the prospective payment system: forecasting social implications. Bioethics ResearchLibrary. 1984. [Link] 
  7. Goldfield N. The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital. Qual Manag Health Care. 2010;19(1):3-16. [Crossref]  [PubMed] 
  8. Wiley M. From the origins of DRGs to their implementation in Europe. In: Busse R, Geissler A, Quentin W, Wiley M, eds. Diagnosis-Related Groups in Europe: Moving Towards Transparency, Efficiency and Quality in Hospitals. 1st ed. Maidenhead: Open University Press; 2011.
  9. Mathauer I, Wittenbecher F. Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries. Bull World Health Organ. 2013;91(10):746-56A. [Crossref]  [PubMed]  [PMC] 
  10. Quentin W, Geissler A, Scheller-Kreinsen D, Busse R. Understanding DRGs and DRG-based hospital payment in Europe. In: Busse R, Geissler A, Quentin W, Wiley M, eds. Diagnosis-Related Groups in Europe: Moving Towards Transparency, Efficiency and Quality in Hospitals. 1st ed. Maidenhead: Open University Press; 2011. p.23-36.
  11. Mathauer I, Wittenbecher F. DRG-based payments systems in low-and middle-income countries: Implementation experiences and challenges. Geneva: World Health Organization; 2012. [Link] 
  12. Klein A, Mathauer I, Stenberg K, Habicht T. Diagnosis-related groups: a question and answer guide on case-based classification and payment systems. Geneva: WHO; 2020. [Link] 
  13. Kobel C, Thuilliez J, Bellanger M, Pfeiffer K-P. DRG systems and similar patient classification systems in Europe. In: Busse R, Geissler A, Quentin W, Wiley M, eds. Diagnosis-Related Groups in Europe: Moving Towards Transparency, Efficiency and Quality in Hospitals. 1st ed. Maidenhead: Open University Press; 2011. p.37-58.
  14. O'Dougherty S, Cashin C, Samyshkin E, Ibraimova A, Katsaga A, Kutanov E, et al. Case-based hospital payment systems. In: Jack Langenbrunner CC, Sheila O'Dougherty, eds. Designing and Implementing Health Care Provider Payment Systems: How-to Manuals. Washington, D.C: The World Bank; 2009. p.125-214.
  15. Özkan O, Ağırbaş İ. Sağlık Bakanlığı global bütçesinin teşhis ilişkili gruplara göre dağitımı [Distribution of Ministry of Health global budget according to diagnosis related groups]. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71(3):163-71. [Crossref] 
  16. T.C. Sağlık Bakanlığı, Sağlık Hizmetleri Genel Müdürlüğü. Teşhis İlişkili Gruplar Bilgilendirme Rehberi. Ankara: 2014. [Link] 
  17. Brolin Ribacke KJ, Saulnier DD, Eriksson A, von Schreeb J. Effects of the West Africa ebola virus disease on health-care utilization-a systematic review. Front Public Health. 2016;4:222. [Crossref]  [PubMed]  [PMC] 
  18. WHO. Pulse survey on continuity of essential health services during the COVID-19 pandemic: interim report, 27 August 2020. Geneva: World Health Organization; 2020. [Link] 
  19. Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8(7):e901-8. [Crossref]  [PubMed]  [PMC] 
  20. Ahmed SAKS, Ajisola M, Azeem K, Bakibinga P, Chen YF, Choudhury NN, et al; Improving Health in Slums Collaborative. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Health. 2020;5(8):e003042. [Crossref]  [PubMed]  [PMC] 
  21. Bolkan HA, Bash-Taqi DA, Samai M, Gerdin M, von Schreeb J. Ebola and indirect effects on health service function in sierra leone. PLoS Curr. 2014;6:ecurrents.outbreaks.0307d588df619f9c9447f8ead5b72b2d. [PubMed]  [PMC] 
  22. Delamou A, Hammonds RM, Caluwaerts S, Utz B, Delvaux T. Ebola in Africa: beyond epidemics, reproductive health in crisis. Lancet. 2014;384(9960):2105. [Crossref]  [PubMed] 
  23. Kapsner LA, Kampf MO, Seuchter SA, Gruendner J, Gulden C, Mate S, et al. Reduced rate of inpatient hospital admissions in 18 german university hospitals during the COVID-19 lockdown. Front Public Health. 2021;8:594117. [Crossref]  [PubMed]  [PMC] 
  24. Oseran AS, Nash D, Kim C, Moisuk S, Lai PY, Pyhtila J, et al. Changes in hospital admissions for urgent conditions during COVID-19 pandemic. Am J Manag Care. 2020;26(8):327-8. [Crossref]  [PubMed] 
  25. Sağlık Bakanlığı [İnternet]. © 2022 T.C. Sağlık Bakanlığı. [Erişim tarihi: 13 Mart 2022]. COVID-19 Bilgilendirme Platformu. Erişim linki: [Link] 
  26. Sağlık Hizmetleri Genel Müdürlüğü. COVID-19 Normalleşme Süreci ve Alınacak Tedbirler 2020. Erişim tarihi: 24 Mayıs 2021. Erişim linki: [Link] 
  27. Elston JW, Moosa AJ, Moses F, Walker G, Dotta N, Waldman RJ, et al. Impact of the Ebola outbreak on health systems and population health in Sierra Leone. J Public Health (Oxf). 2016;38(4):673-8. [PubMed] 
  28. WHO. Managing epidemics: key facts about major deadly diseases. Geneva: World Health Organization; 2018. [Link] 
  29. Sevinc M, Hasbal NB, Sakaci T, Basturk T, Ahbap E, Ortaboz M, et al. Frequency of depressive symptoms in Syrian refugees and Turkish maintenance hemodialysis patients during COVID-19 pandemic. PLoS One. 2021;16(1):e0244347. [Crossref]  [PubMed]  [PMC] 
  30. von Dercks N, Seehofer D, Steinert M, Krämer S, Branzan D, Dietrich A, et al. n [How severe is the effect of the coronavirus pandemic on the department of surgery of a university hospital? : an analysis of the first 7 weeks]. Chirurg. 2020;91(9):755-61. [Crossref]  [PubMed]  [PMC] 
  31. Özkan O, Ağırbaş İ. Sağlık hizmetlerinde geri ödeme modelleri: teşhis ilişkili gruplar ve vaka karması. Ankara Üniversitesi Tp Fakültesi Mecmuası. 2016;69(1):21-8. [Crossref] 
  32. Işıkçelik F, Öztürk N, Ağırbaş İ. Sağlık hizmetlerinde geri ödeme yöntemlerinden teşhis ilişkili gruplar. SGD-Sosyal Güvenlik Dergisi. 2019;9(2):431-48. [Crossref] 
  33. Chen Y, Wang L, Cui X, Xu J, Xu Y, Yang Z, et al. COVID-19 as an opportunity to reveal the impact of large hospital expansion on the healthcare delivery system: evidence from Shanghai, China. Ann Transl Med. 2021;9(16):1297. [Crossref]  [PubMed]  [PMC] 

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