ICR BETA - VALUE OF EACH PARAMETER

The French health policy PMSI project (Program for a Medical Informati on System) is mainly aimed at development of cost analysis based on di agnosis related groups. An indicator of the relative costs of anaesthe tics, the relative complexity index (ICR beta), was defined as the res ult of a computation of different indexes of surgical and anaesthetic procedures such as duration, patients ASA status, degree of emergency, stay in the recovery room. The aims of this study were 1) to analyze relative part of each index in ICR beta value and in ICR beta variance and 2) to assess the value of ICR beta as a cost or a complexity inde x. The study included 14,435 anaesthetics analyzed with the Dunn and C larks multiple linear regression. Mean ICR beta was 267.28. The durati on of the procedure accounted for 46 % of the ICR beta value and surge ry for 25 %. The anaesthesia and the recovery accounted for 15 % of th e ICR beta value, but only for 0.0341 and 0.0347 respectively of the I CR beta variance. The product of the surgical procedure index by the A SA status index accounted for 0.259 of the ICR beta variance and the d uration index for 0.650. The comparison of homogeneous groups with reg ard to the surgical procedure shows that intravenous anaesthesia accou nts for 12.4 % of the ICR beta value, inhalational anaesthesia for 13. 84 %, but exceeds 15 % for regional anaesthesia (44.5 % for caudal ana esthesia). For appendicectomies (n = 114) duration index is still an i mportant parameter in ICR beta variance (Delta R2 = 0.354) but equival ent to the emergency index (Delta R2 = 0.363). For hip arthroplasties (n = 452) the ASA status index is the major parameter in the ICR beta variance (Delta R2 = 0.391). For these two surgical procedures, anaest hesia index accounts for less than 4 % of the ICR beta variance. These results confirm previous ones. They point on inadequacies and large c omplexity of this index. In the future a ''relative cost index'' shoul d be defined, in adding medical and nurse activity, costs of drugs and equipments, and a ''difficulty index'' including the level of qualifi cation required to perform the anaesthesia and the difficulties encoun tered for its achievement.