7 eliminate certain secondary diagnoses from the

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7. Eliminate certain secondary diagnoses from the determination of the risk of mortality subclass of the patient This step is identical to the corresponding step in the determination of the severity of illness sub- class. Secondary diagnoses that are related to other secondary diagnoses have their risk of mortality level reduced to minor. 8. Combine all secondary diagnoses to determine the base risk of mortality subclass of the patient Once secondary diagnoses that are related to other secondary diagnoses have their risk of mor- tality level reduced to minor, the base patient risk of mortality subclass is set equal to the maximum risk of mortality level across all of the remaining secondary diagnoses. This is done the same way as for severity of illness. For example, if there are five remaining secondary diagnoses and one is a major risk of mortality level and four are a moderate risk of mortality level, then the base patient risk of mortality subclass is major. 9. Reduce the base risk of mortality subclass if the patient does not have multiple secondary diagnoses with a significant risk of mortality, except for certain secondary diagnoses for which this requirement is removed or modified In general, high risk of mortality patients are characterized by multiple secondary diagnoses with a significant risk of mortality. In order for the base risk of mortality subclass to be extreme, there must be two or more extreme risk of mortality secondary diagnoses present or a single extreme
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50 risk of mortality secondary diagnosis plus two or more major risk of mortality secondary diag- noses. If this multiple criteria is not met, the patient’s base risk of mortality subclass is lowered to either major or moderate. If the multiple criteria is not met, but in addition to a single extreme risk of mortality secondary diagnosis there is at least one other major or moderate secondary diagno- sis, then the patient’s risk of mortality subclass is lowered to major. If there is not at least one other major or moderate secondary diagnosis in addition to an extreme risk of mortality secondary diagnosis, then the patient’s base risk of mortality subclass is lowered to moderate. There are, however, two exceptions to these criteria. There is one set of secondary diagnoses that have such an inherent high risk of mortality that no other secondary diagnoses are required for the patient’s base risk of mortality subclass to be extreme. Examples include: pulmonary anthrax, rup- tured aortic aneurism, hepatorenal syndrome, head trauma with deep coma, and 60-90% body burn/50-59% third degree. There is a second set of secondary diagnoses that also have an inher- ently high risk of mortality and for which only one other major secondary diagnosis is required for the patient’s base risk of mortality to be extreme. Examples included: defibrination syndrome, acute myocardial infarct, intracranial hemorrhage, cerebral thrombosis with infarct, dissection of aortic aneurism, acute respiratory failure, acute renal failure, and shock.
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  • Fall '18
  • Diagnosis-related group, DRGs

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