Increased demand for a patient classification system

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increased demand for a patient classification system that can be used for applications beyond resource use, cost, and payment. In particular, a patient classification system is needed for: The comparison of hospitals across a wide range of resource and outcome measures. Such comparisons are typically disseminated to the public by state data commissions The evaluation of differences in inpatient mortality rates The implementation and support of critical pathways The identification of continuous quality improvement projects The basis of internal management and planning systems The management of capitated payment arrangements In order to meet these needs, the objective of the DRG system needed to be expanded in scope to address patient severity of illness and risk of mortality as well as resource intensity. As previ- ously defined, these patient attributes have the following meaning: Severity of illness. The extent of physiologic decompensation or organ system loss of function. Risk of mortality. The likelihood of dying. Resource intensity. The relative volume and types of diagnostic, therapeutic, and bed services used in the management of a particular disease. The APR-DRGs expand the basic DRG structure by adding four subclasses to each DRG. The addition of the four subclasses addresses patient differences relating to severity of illness and risk of mortality. Severity of illness and risk of mortality relate to distinct patient attributes. For exam- ple, a patient with acute choledocholithiasis (acute gallstone attack) as the highest secondary diagnosis may be considered a major severity of illness but only a minor risk of mortality. The severity of illness is major since there is significant organ system dysfunction associated with acute choledocholithiasis. However, it is unlikely that the acute episode alone will result in patient mortality and thus, the risk of mortality for this patient is minor. If additional, more serious diag- noses are also present, patient severity of illness and risk of mortality may increase. For example, if peritonitis is present along with the acute choledocholithiasis, the patient may be considered an extreme severity of illness and a major risk of mortality. Since severity of illness and risk of mortal- ity are distinct patient attributes, separate subclasses are assigned to a patient for severity of illness and risk of mortality. Thus, in the APR-DRG system a patient is assigned three distinct descriptors: The base APR-DRG (e.g., APR-DRG 194 Heart Failure or APR-DRG 440 Kidney Transplant) The severity of illness subclass The risk of mortality subclass The four severity of illness subclasses and the four risk of mortality subclasses are numbered sequentially from 1 to 4 indicating respectively, minor, moderate, major, or extreme severity of ill- ness or risk of mortality. For applications such as evaluating resource use or establishing patient
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22 care guidelines, the APR-DRG in conjunction with severity of illness subclass is used. For evalu-
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  • Fall '18
  • Diagnosis-related group, DRGs

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