ArticleBMC nursing2026
Hidden nursing complexity within diagnosis-related groups (DRGs): a one-year retrospective study of standardized nursing diagnoses and actions among adult hospitalizations in Italy.
Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
4 citing papers in PubMed.
- Evaluating Humanisation in Intensive Care Nursing Practice: An Exploratory Study Using the HUMAS Scale.Journal of evaluation in clinical practice · 2026Article
- Association Between Spiritual Care Competence and Palliative Care Quality Among Palliative Care Nurses: A Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2026Article
- Dynamic Neutrophil-to-Lymphocyte Ratio Stratifies Survival and Immune-Related Adverse Events in Lung and Gastric Cancer Patients with Immunotherapy.Cancer management and research · 2026Article
- Mapping Family Involvement in Prehabilitation for Patients Undergoing Cancer Surgery: A Scoping Review.Journal of multidisciplinary healthcare · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDiagnosis-related groups (DRGs) are used within prospective payment systems to classify hospitalizations and standardize reimbursement but may insufficiently capture nursing complexity. This study aimed to describe the variability in nursing complexity within the most prevalent DRGs among adult inpatients and to examine its relationship with DRG-specific length of stay thresholds and DRG weight.
methodsAdult hospitalizations discharged in 2022 from a large acute-care hospital in Rome, Italy, were analyzed. Nursing complexity was measured using counts of nursing diagnoses documented within 24 hours of admission and nursing actions recorded throughout hospitalization. Variability within and across DRGs was explored descriptively. Comparisons were conducted between hospitalizations within and exceeding DRG-specific length of stay thresholds. Linear regression models examined the proportion of variability in nursing complexity explained by DRG weight, both before and after adjustment for demographic and clinical variables.
resultsThe study included 14,169 hospitalizations across the 20 most frequent DRGs. Marked variability in nursing diagnoses and nursing actions was observed not only between DRGs but also within the same DRG, with counts ranging from 1 to 17 for nursing diagnoses and from 1 to 770 for nursing actions. Patients classified as medically similar under the same DRG exhibited substantial heterogeneity in nursing complexity. Hospitalizations exceeding DRG-specific length of stay thresholds showed consistently higher nursing complexity compared to those remaining within expected limits, both in terms of nursing diagnoses (mean 7.5, SD 4.3 vs. 4.0, SD 2.5; Welch's t(265.2) = -13.0, p < 0.001; Cohen's d = 1.0, 95% CI 0.9-1.1) and nursing actions (median 50, IQR 45 vs. 17, IQR 10; Mann-Whitney U = 311249, Z = -23.1, p < 0.001; r = 0.19). In univariable models, DRG weight showed modest associations with nursing diagnoses (β = 0.140, p < 0.001; R
conclusionsDRGs do not adequately capture nursing complexity. Integrating standardized nursing data into hospital resource utilization and risk-adjustment models may improve the visibility of nursing care and support more accurate resource allocation in hospital financing systems.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.