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Le Programme de Médicalisation des Systèmes d’Information (PMSI) est aujourd’hui le référentiel national pour le financement des établissements hospitaliers en France, dans le contexte d’une tarification à l’activité (T2A). Renvoyant à des enjeux financiers importants, mais aussi d’évaluation de l’activité hospitalière, notre étude propose une évaluation de la cohérence clinique de la durée de séjour et du statut de sortie de nouveau-nés de très faible poids de naissance (1, et incombant à l’Assurance Maladie. L’étude démontre la nécessité d’une évaluation de l’exhaustivité et de la validité des variables intervenant dans la valorisation économique des séjours ainsi que dans l’évaluation de l’activité hospitalière en néonatologie. L’apport d’informations supplémentaires est suggéré, pouvant constituer des indicateurs cliniques essentiels susceptibles d’améliorer a priori la tarification à l’activité en néonatalogie.

Validity and issues of the French DRG coding concerning short stays in neonatology in infants of low birth weightThe French DRG (Diagnostics Related Groups) model is now the national repository for the financing of Hospitals in France, in the context of tariff-based activity. Referring to the significant financial challenges, but also evaluation of hospital activity, our study provides an assessment of the clinical coherence of the length of stay and exit status in infants of very low birth weight (<1500g). Corresponding stays are extracted from the DRG database for 2005 and 2006. A first descriptive analysis identified a bimodal distribution of lengths of stay, with a first mode to two days. A second analysis calls into question the coherence of the “home” exit status, in view of an estimated weight at discharge (30% of newborns weighing less than 1000g at admission came out at home before reaching 1700g). The majority of associated lengths of stay were lower than the 10th percentile of the distribution. Some cases (such as the presence of diagnoses of foetal death) led to calculate the amount of financial undue, based on official tariffs applied to DRG for newborns, premature and conditions of the perinatal period, and applicable to the Health Insurance. The study demonstrates the need for assessment of the completeness and validity of variables involved in the economic recovery of stays and in the evaluation of hospital activity in neonatology. Providing additional information is suggested, may be essential clinical indicators to improve the pricing activity in neonatology.