Resource intensity refers to the relative volume and

Info icon This preview shows pages 10–11. Sign up to view the full content.

Resource Intensity. Refers to the relative volume and types of diagnostic, therapeutic, and bed services used in the management of a particular illness. When clinicians use the notion of case mix complexity, they typically are referring to one or more aspects of clinical complexity. For clinicians, increased case mix complexity refers to greater severity of illness, greater risk of mortality, greater treatment difficulty, poorer prognoses, and/or a greater need for intervention. Thus, from a clinical perspective, case mix complexity refers to the condition of the patients treated and the treatment difficulty associated with providing care. On the other hand, administrators and regulators usually use the concept of case mix complexity to indi- cate that the patients treated require more resources which results in a higher cost of providing care. Thus, from an administrative or regulatory perspective, case mix complexity refers to the resource intensity demands that patients place on an institution. While the two interpretations of case mix complexity are often closely related, they can be very different for certain kinds of patients. For example, while terminal cancer patients are very severely ill and have a poor prog- nosis, they require few hospital resources beyond basic nursing care. No measure of case mix complexity can be equally effective for all the different aspects of case mix complexity. There has sometimes been confusion regarding the use and interpretation of the DRGs because the aspect of case mix complexity measured by the DRGs has not been clearly understood. The purpose of the DRGs is to relate a hospital’s case mix to the resource demands and associated costs experienced by the hospital. Therefore, a hospital having a more complex case mix from a DRG perspective means that the hospital treats patients who require more hospital resources, but not necessarily that the hospital treats patient having a greater severity of illness, a greater risk of dying, a greater treatment difficulty, a poorer prognosis, or a greater need for intervention. Patient classification Given that the purpose of the DRGs is to relate a hospital’s case mix to its resource intensity, it was necessary to develop an operational means of determining the types of patients treated and relating each patient type to the resources they consumed. While all patients are unique, groups of patients have demographic, diagnostic, and therapeutic attributes in common that determine their level of resource intensity. By developing clinically similar groups of patients with similar resource intensity, patients can be aggregated into meaningful patient groups. Moreover, if these patient groups covered the entire range of patients seen in an inpatient setting, then collectively they would constitute a patient classification scheme that would provide a means of establishing and measuring hospital case mix complexity. The DRGs were therefore developed as a patient
Image of page 10

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Image of page 11
This is the end of the preview. Sign up to access the rest of the document.
  • Fall '18
  • Diagnosis-related group, DRGs

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern