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The use of hospital administrative data in assessing the severity of illness of inpatients.

Record Type:	Electronic resources : Monograph/item
Title/Author:	The use of hospital administrative data in assessing the severity of illness of inpatients./
Author:	Yang, Che-Ming.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2003,
Description:	263 p.
Notes:	Source: Dissertations Abstracts International, Volume: 65-01, Section: B.
Contained By:	Dissertations Abstracts International65-01B.
Subject:	Health care. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3080800
ISBN:	9780496286744

The use of hospital administrative data in assessing the severity of illness of inpatients.
Yang, Che-Ming.

The use of hospital administrative data in assessing the severity of illness of inpatients. - Ann Arbor : ProQuest Dissertations & Theses, 2003 - 263 p.

Source: Dissertations Abstracts International, Volume: 65-01, Section: B.

Thesis (Ph.D.)--The Johns Hopkins University, 2003.

This item must not be sold to any third party vendors.

Severity of illness is an omnipresent confounder in any study of patient outcomes or of the effectiveness of medical care. This study focuses on finding severity of illness measures that are administratively feasible. The research objectives are to ascertain the construct validity of severity indices derived from administrative data in comparison with clinical data; to ascertain correlations among the average costs of treating patients, hospital characteristics, and severity measures; to develop better severity estimation algorithms; and to facilitate severity adjustment in health services research. Comparison of relative performance of all approximation methods was based upon the correlations of each individual method with the Acute Physiology and Chronic Health Evaluation (APACHE) II index and the Medicare Diagnosis Related Group (DRG) Case Mix Index (CMI). The study population included all hospitals of the general acute care type which have participated in the Department of Health (DOH) accreditation in Taiwan. 551 hospitals were included. For comparison of clinical aspects, the best approximation method for the aggregate APACHE II severity are the International Classification of Disease (ICD) principal diagnosis-based length of stay CMI (ICDCMI-D). On the administrative side, the ICD principal diagnosis-based costliness (ICDCMI-C) is the best non-DRG alternative to DRGCMI. Of the non-CMI methods, the relative costliness index (COSDEX) provides the best approximation for DRGCMI, followed by the relative average length of stay index (ALOSDEX) and the major illness user fee waiver rate index (COPAYDEX). Teaching status, numbers of acute care beds, locations and ownership have significant impacts on the aggregate severity of illness of individual hospitals in the multiple regression analyses. The results of our study indicate that the notion of case mix is still better than the non-case-mix type of severity-of-illness index for assessing the aggregate severity of individual hospitals. ICD-based CMIs can quite satisfactorily approximate the Medicare DRGCMI. Therefore, the idea of substituting ICD for DRG in computing the CMI is feasible in countries like Taiwan that have not implemented Medicare DRGs. In addition, the performance of the major illness user fee waiver applied as a severity of illness proxy is quite remarkable as shown by the study results.

ISBN: 9780496286744Subjects--Topical Terms:

2213177
Health care.
Subjects--Index Terms:

Case mix

The use of hospital administrative data in assessing the severity of illness of inpatients.
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520 $a Severity of illness is an omnipresent confounder in any study of patient outcomes or of the effectiveness of medical care. This study focuses on finding severity of illness measures that are administratively feasible. The research objectives are to ascertain the construct validity of severity indices derived from administrative data in comparison with clinical data; to ascertain correlations among the average costs of treating patients, hospital characteristics, and severity measures; to develop better severity estimation algorithms; and to facilitate severity adjustment in health services research. Comparison of relative performance of all approximation methods was based upon the correlations of each individual method with the Acute Physiology and Chronic Health Evaluation (APACHE) II index and the Medicare Diagnosis Related Group (DRG) Case Mix Index (CMI). The study population included all hospitals of the general acute care type which have participated in the Department of Health (DOH) accreditation in Taiwan. 551 hospitals were included. For comparison of clinical aspects, the best approximation method for the aggregate APACHE II severity are the International Classification of Disease (ICD) principal diagnosis-based length of stay CMI (ICDCMI-D). On the administrative side, the ICD principal diagnosis-based costliness (ICDCMI-C) is the best non-DRG alternative to DRGCMI. Of the non-CMI methods, the relative costliness index (COSDEX) provides the best approximation for DRGCMI, followed by the relative average length of stay index (ALOSDEX) and the major illness user fee waiver rate index (COPAYDEX). Teaching status, numbers of acute care beds, locations and ownership have significant impacts on the aggregate severity of illness of individual hospitals in the multiple regression analyses. The results of our study indicate that the notion of case mix is still better than the non-case-mix type of severity-of-illness index for assessing the aggregate severity of individual hospitals. ICD-based CMIs can quite satisfactorily approximate the Medicare DRGCMI. Therefore, the idea of substituting ICD for DRG in computing the CMI is feasible in countries like Taiwan that have not implemented Medicare DRGs. In addition, the performance of the major illness user fee waiver applied as a severity of illness proxy is quite remarkable as shown by the study results.
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