Short Info: Disease Staging (USA)

The development of the D.S. system1 began in the late 70s, at about the same time as DRGs (Diagnosis Related Groups). Unlike in the case of DRGs, the D.S. concept is based on a purely medical expert approach, and not upon statistical considerations.

The system describes "diseases". Each disease is considered to run through various "stages". Inspired from the disease staging concept known in oncology, medical consultants have defined stages for 372 clinical conditions. In addition, 224 categories for not specifically defined conditions are present (e. g. "other malignant neoplasms of the circulatory system", "not otherwise specified heart diseases", "unspecified heart diseases" etc.).

The disease stage is derived from all the diagnoses that were collected during the hospital stay of a patient. It is related to the mortality risk or the risk of retaining a disability from the disease. The treatment intended is not considered. (This allows for clear distinction between patient problems and therapy characteristics!)

The stages are as follows:

• Stage 1: A disease with no complications.
• Stage 2: The disease has local complications. (The problem is limited to an organ or body system; there is a significantly increased risk of complications.)
• Stage 3: The disease involves multiple sites, or has systemic complications. (Prognosis is bad.)
• Stage 4: Death (occurred during the hospital stay).

Often, the D.S. system was used to demonstrate inhomogenity of DRGs. This task is facilitated through the D.S. system's software, using a special index: The "DRGSCALE" figure shows, how much the cost weight of an individual hospital stay deviates from the DRG-related average value.