Linking nursing care to medical diagnoses: Heterogeneity of patient groups

Summary 

Aim

The new budget system for Dutch hospitals makes use of patient groups that are highly homogeneous in terms of diagnosis and treatment combinations (diagnose behandeling combinaties (DBC)). These DBCs are the Dutch DRG variants. The DBC mainly concerns medical care; nursing care is almost regarded as a constant factor. In this study the DBC is linked to the nursing minimum data set for The Netherlands (NMDSN), to explore the degree of homogeneity in terms of nursing care for patient groups that are homogeneous in terms of the DBC.

Method

In nine Dutch hospitals, patient information was collected by means of the NMDSN. To answer the question, we performed a secondary data analysis on the NMDSN. First, groups were formed in terms of medical diagnoses as defined in the DBC. Next, explorative statistical analyses were used to form homogeneous groups in terms of nursing diagnoses. These groups were compared in terms of the nursing care interventions and in terms of medical diagnoses.

Finding

Some medical diagnoses seem to be homogeneous, others more heterogeneous in terms of nursing care.

Discussion and conclusion

Limitations in the study design hinder a firm conclusion. However, the results discourage the use of the medical DBC for nursing care.

Keywords: Budgeting, Dutch hospitals, DRG/DBC, Nursing minimum data set, Registration of care, Diversity, Variations, Homogeneity, Heterogeneity