Skip to main content
SpringerLink
Log in

DRGs and severity of illness measures: An analysis of patient classification systems

  • Articles
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Concerns about inefficiency and excessive expenditures has stimulated interest in the measurement of the output of the hospital, an organization that produces a wide variety of products. Diagnosis Related Groups and a number of severity measures including Disease Staging, the Severity of Illness Index, and Patient Management Categories are described and evaluated. Using criteria such as reliability, clinical validity, homogeneity, number of categories, and data acquisition costs, the analysis suggests that while none of the hospital patient classification systems is perfect, great strides have been made in reflecting the multiproduct nature of the hospital.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rosko, M.D., and Broyles, R.W.,The Economics of Health: A Reference Handbook, Greenwood Press, Westport, Conn., 1988.

    Google Scholar 

  2. Broyles, R.W., and Rosko, M.D.,Planning and Internal Control Under Prospective Payment, Aspen Publishers, Inc., Rockville, Md., 1986.

    Google Scholar 

  3. Hornbrook, M.C., Hospital Case Mix: Its definition, measurement and use: Part II. Review of alternative measures.Med. Care Rev. 39(2):73–123, 1982.

    Google Scholar 

  4. Wagner, D.P., and Draper, E.A., Acute physiology and chronic health evaluation (APACHE II).Health Care Financing Rev. (Annu. Suppl.):11–105, 1984.

  5. Brewster, A.C., Jacobs, C.M., and Bradbury, R.C., Classifying severity of illness by using clinical findings.Health Care Financing Rev. (Annu. Suppl.):107–108, 1984.

  6. Fetter, R.B., Mills, R.E., Riedel, D.C., and Thompson, J.D., The application of diagnostic specific cost profiles to cost and reimbursement control in hospitals.J. Med. Syst. 1(2):137–149, 1977.

    Google Scholar 

  7. Pettengill, J., and Vertrees, J., Reliability and validity in hospital case-mix measurement.Health Care Financing Rev. 4(2):101–128, 1982.

    Google Scholar 

  8. Gonnella, J.S., and Goran, M.J., Quality of patient care—A measurement of change: The staging concept.Med. Care 13(6):467–473, 1975.

    Google Scholar 

  9. Gonnella, J.S., Hornbrook, M., and Louis, D., Staging of disease: A case-mix measurement.JAMA 251(5):637–644, 1984.

    Google Scholar 

  10. Horn, S.D., Validity, reliability and implications of an index of inpatient severity of illness.Med. Care 19(3):354–362, 1981.

    Google Scholar 

  11. Horn, S.D., Horn, R.A., Sharkey, P.D., The Severity of Illness Index as a severity adjustment to diagnosis-related groups.Health Care Financing Rev. (Suppl.):33–45, 1984.

  12. Horn, S.D., and Horn, R.A., Reliability and validity of the severity of illness index.Med. Care 24(2):159–169, 1986.

    Google Scholar 

  13. Horn, S.D., Chachich, B., and Clopton, C., Measuring severity of illness: A reliability study.Med. Care 21(7):705–714, 1983.

    Google Scholar 

  14. Muller, C., Paying hospitals: How does a severity measure help?Am. J. Public Health 73(1):14–15, 1983.

    Google Scholar 

  15. Schumacher, D.N., Parker, B., Kofie, V., and Munns, J.M., Severity of Illness Index and the Adverse Patient Occurrence Index: A reliability study and policy implications.Med. Care 25(8):695–704, 1987.

    Google Scholar 

  16. Horn, S.D., and Horn, R.A., The Computerized Severity Index: A new tool for case-mix management.J. Med. Syst. 10(1):73–78, 1986.

    Google Scholar 

  17. Young, W.W., Patient management categories. Paper presented at Annual meeting of American Public Health Association, Anaheim, Calif., Nov. 14, 1984.

  18. Young, W.W., Swinkola, R.B., and Zorn, D.M., The measurement of hospital case mix.Med. Care 29(5):501–512, 1982.

    Google Scholar 

  19. Young, W.W., Incorporating severity of illness and comorbidity in case-mix measurement.Health Care Financing Rev. 5(Suppl.):23–46, 1984.

    Google Scholar 

  20. Ament, R.P., Kobrinski, E.J., and Wood, W.R., Case mix complexity differences between teaching and nonteaching hospitals.J. Med. Ed. 56(11):894–903, 1981.

    Google Scholar 

  21. Reliability of National Hospital Discharge Survey Data. Institute of Medicine Publication No. 10M80-02, Washington, D.C., 1980.

  22. Ginsburg, P., and Carter, G., The Medicare Case-Mix Index increase.Health Care Financing Rev. 7(Summer):51–66, 1986.

    Google Scholar 

  23. Fetter, R.B., Shin, Y., Freeman, J.C., Averill, R.F., and Thompson, J.D., Case mix definition by diagnosis-related groups.Med Care 18(2):1–53, 1980.

    Google Scholar 

  24. Gertman, P.M., and Lowenstein, S., A research paradigm for severity of illness: Issues for the diagnosis-related group system.Health Care Financing Rev. 5(Suppl.):79–90, 1984.

    Google Scholar 

  25. Doremus, H., and Michenzi, E., Data quality: An illustration of its potential impact upon a diagnosis-related group's case-mix index and reimbursement.Med. Care 21:1001–1011, 1983.

    Google Scholar 

  26. Broyles, R.W., and Rosko, M.D., A qualitative assessment of the Medicare prospective payment system.Soc. Sci. Med. 10:1885–1190, 1985.

    Google Scholar 

  27. Smits, H.L., Fetter, R.B., and McMahon, L.F., Variation in resource use within diagnosis-related groups: The severity issue.Health Care Financing Rev. 5(Suppl.):71–78, 1984.

    Google Scholar 

  28. Spiegel, A.D., and Kavaler, F.,Cost Containment and DRGs: A Guide to Prospective Payment. Owings Mills, Md.: National Health Publishing, 1987.

    Google Scholar 

  29. Horn, S.D., Sharkey, P.D., Chambers, A.F., and Horn, R.A., Severity of illness within DRGs: Impact on prospective payment.Am. J. Public Health 75(10):1195–1199, 1985.

    Google Scholar 

  30. Ament, R.P., Dreachslin, J.L., Kobrinski, E.J., and Wood, W.R., Three case-type classifications: Suitability for use in reimbursing hospitals.Med. Care 20(5):460–467, 1982.

    Google Scholar 

  31. Horn, S.D., and Sharkey, P.D., Measuring severity of illness to predict patient resource use within DRGs.Inquiry 20:314–321, 1983.

    Google Scholar 

  32. Horn, S.D., Sharkey, P.D., and Bertram, D.A., Measuring severity of illness: Homogeneous case mix groups.Med. Care 21(1):14–25, 1983.

    Google Scholar 

  33. Calore, K.A. and Iezzoni, L., Disease staging and PMCs: Can they improve DRGs?Med. Care 25(8):724–737, 1987.

    Google Scholar 

  34. Frank, R.G., and Lave, J.R., The psychiatric DRGs: Are they different?Med. Care 23(10):1148–1155, 1985.

    Google Scholar 

  35. Taube, C., Lee, E.S., and Forthofer, R.N., DRGs in psychiatry: An empirical evaluation.Med. Care 22(7):597–610, 1984.

    Google Scholar 

  36. Anderson, G.F., and Lave, J.R., Financing graduate medical education using multiple regression to set payment rates.Inquiry 23:191–199, 1986.

    Google Scholar 

  37. Horn, S.D., Bulkley, G., Sharkey, P.D., Chambers, A.F., Horn, R.A., and Schramm, C.J., Interhospital differences in severity of illness.N. Engl. J. Med. 313:20–24, 1985.

    Google Scholar 

  38. Horn, S.D., Horn, R.A., Sharkey, P.D., and Chambers, A.F., Severity of illness within DRGs: Homogeneity study.Med. Care 24(3):225–235, 1986.

    Google Scholar 

  39. Conklin, J.E., Lieberman, J.V., Barnes, C.A., and Louis, D.Z., Disease staging: Implications for hospital reimbursement and management.Health Care Financing Rev. 5(Suppl.):13–22, 1984.

    Google Scholar 

  40. Coffey, R., and Goldfarb, M., DRGs and disease staging for reimbursement medicare patients.Med. Care 24(9):814–829, 1986.

    Google Scholar 

  41. Johansen, S., Comparison of two prospective rate-setting models: The DRG and PIR models.Health Serv. Res. 21(4):547–559, 1986.

    Google Scholar 

  42. DesHarnais, S.I., Chesney, J.D., and Fleming, S.T., Should DRG assignment be based on age?Med. Care 26(2):124–131, 1988.

    Google Scholar 

  43. McNeil, B., Kominski, G., and Williams-Ashman, A., Modified DRGs as evidence for variability in patients severity.Med. Care 26(1):53–61, 1988.

    Google Scholar 

  44. Wood, W.R., Ament, R.P., and Kobrinski, E.J., A foundation for hospital case-mix measurement.Inquiry 18(3):247–254, 1981.

    Google Scholar 

  45. Thomas, J.W., Ashcraft, M.L., and Zimmerman, J., An evaluation of alternative severity of illness measures for use by University Hospitals, Vol. II: Technical Report. University of Michigan School of Public Health, 1986.

  46. McIlrath, S., Review systems based on illness severity.Am. Med. News 28(2):2,17–18, 1985.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Department of Health and Medical Services Administration, Widener University, 19013, Chester, Pennsylvania

    Michael D. Rosko Ph.D.

Authors
  1. Michael D. Rosko Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rosko, M.D. DRGs and severity of illness measures: An analysis of patient classification systems. J Med Syst 12, 257–274 (1988). https://doi.org/10.1007/BF00999504

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00999504

Keywords

Search

Navigation