Patients with a base risk of mortality subclass of

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Patients with a base risk of mortality subclass of major are reduced to moderate unless, in addi- tion to the major risk of mortality secondary diagnosis, there is at least one additional major risk of mortality secondary diagnosis or two more additional secondary diagnoses with a moderate risk of mortality. If this multiple criteria is not met 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 a sufficiently high inherent risk of mortality that no other second- ary diagnoses are required for the patient’s base risk of mortality subclass to be set at major. Examples include: flail chest, major liver laceration, 40-49% body burns/10-19% third degree. There is a second set of secondary diagnoses that have a significant inherent risk of mortality so that only one moderate secondary diagnoses is required for the patient’s base risk of mortality subclass to be set at major. Examples include: food/vomit pneomonitis, acute lung edema, and perforation of intestine. Patients with a base risk of mortality subclass of moderate are reduced to minor unless there are at least two moderate risk of mortality secondary diagnoses present. There is, however, one exception to this criteria. These moderate risk of mortality secondary diagnoses do not require any other secondary diagnoses to be present. Examples include: malignant neoplasm diagnoses that are moderate risk of mortality level diagnoses, acidosis, bacterial pneumonia, congestive heart failure, chronic renal failure, Alzheimer’s disease, and decubitus ulcer. Phase III—Determine the final risk of mortality subclass of the patient Once the base patient risk of mortality subclass is computed then the risk of mortality subclass may be increased or decreased in Phase III based on specific values of certain patient attributes. In Phase III, the risk of mortality algorithm examines six of the eight patient attributes utilized in Phase III of the severity of illness logic. The two that are not used by risk of mortality are only used to a very limited extent in the severity of illness logic. The patient attributes are: Combinations of APR-DRG and principal diagnosis Combinations of APR-DRG and age, or APR-DRG and principal diagnosis and age, or APR-DRG and birthweight and absence of certain non-OR procedures Combinations of APR-DRG and non-OR procedures Combinations of APR-DRG and OR procedures Combinations of APR-DRG and pairs of OR procedures
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51 Combination of the APR-DRG for ECMO and presence/absence of certain OR procedures (not applicable for risk of mortality) Combinations of APR-DRG and principal diagnoses and non-OR procedures (not applicable for risk of mortality) Combinations of categories of secondary diagnoses In Phase I, age and non-OR procedures were used to modify the standard risk of mortality level of a secondary diagnosis. However, age and non-OR procedures can also have an impact that is specific to the patient’s APR-DRG or a specific principal diagnosis within an APR-DRG. Thus, the
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  • Fall '18
  • Diagnosis-related group, DRGs

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