DRG for rehabilitation in Sweden - joint use of three health-related classifications

Ann-Helene Almborg ^a, Ralph Dahlgren ^a

Introduction
As a Nordic collaboration a grouping logic for rehabilitation was added in 2008 to Nord Diagnosis Related Groups (DRG) at the request of the health organizations. It contained of 33 new DRG groups based on the Nordic Assessment Score manual (NASS manual). The DRG for rehabilitation was using ICD-codes and codes for functioning.

Development in Sweden resulted in increased number of codes for functioning, but the ICF-codes were not used. The DRG system also included some interventions in the Swedish Classification of Health Interventions (KVÅ). This version of the DRG-system was implemented 2011. However, the original grouping characteristics in NordDRG remained. DRG 2021 consisted of 11 grouping pro-perties used for 33 DRG.

Further development 2023 aimed to:

• replace the existing functioning-codes with ICF-codes
• enable the use of additional ICF-codes to describe more areas of functioning
• enable the use of additional rehabilitation interventions from KVÅ
• develop Rehab DRGs for mental health conditions.

Methods
The further development has been performed by review of ICF-codes from following sources:

• existing 18 modified functioning-codes in Nord DRG for rehabilitation (maps to ICF)
• functioning entities in ICD-11 V Chapter Supplementary section for functioning assessment (maps to ICF)
• WHODAS 2.0 (maps to ICF)
• ICF core sets for Rehabilitation
• frequently used ICF-codes in the ICF-core sets (n=40)

The original grouping properties for functioning were used to identify relevant ICF-codes from the sources used in the review. Relevant rehabilitation interventions from KVÅ was identified. ICD-codes for mental health conditions were already identified in NordDRG, but not used for rehabilitation.

Results
ICD-codes are used as main diagnosis. The analyze of the 12 grouping properties for functioning resulted in 90 ICF-codes of which 40 ICF-codes are used for nine new grouping properties for functioning. The remaining 50 ICF-codes are used for another new grouping property. The ICF-codes are used with the qualifiers. The new 10 grouping properties for functioning based on ICF-codes are used for the ten new DRG groups.

Totally are 255 KVÅ-codes for rehabilitation interventions used, The DRG-system for year 2025 consists of 85 DRG for rehabilitation for the 12 groups of health conditions.

Discussion
The updated DRG for rehabilitation will support the joint use of ICF, ICD and KVÅ (interventions). This DRG-system will improve the possibilities to:

• describe the functioning level as complement to the health condition and performed rehabilitation interventions
• joint use of ICF, ICD-10-SE and KVÅ (interventions)
• collect data - to be used at local, regional or national level
• further develop DRG for rehabilitation in other areas such as primary care.
• follow the patient´s functioning level and rehabilitation pathway in health care.

ICD-11 and ICHI will have the same potential use as well.


^a National Board of Health and Welfare, Sweden

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