Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement

D P Wagner, E A Draper, D P Wagner, E A Draper

Abstract

This article describes the potential for the acute physiology score (APS) of acute physiology and chronic health evaluation (APACHE) II, to be used as a severity adjustment to diagnosis-related groups (DRG's) or other diagnostic classifications. The APS is defined by a relative value scale applied to 12 objective physiologic variables routinely measured on most hospitalized patients shortly after hospital admission. For intensive care patients, APS at admission is strongly related to subsequent resource costs of intensive care for 5,790 consecutive admissions to 13 large hospitals, across and within diagnoses. The APS could also be used to evaluate quality of care, medical technology, and the response to changing financial incentives.

Figures

Figure 1. The acute physiology and chronic…
Figure 1. The acute physiology and chronic health evaluation (APACHE) II severity of disease classification system
Figure 2. Therapeutic intervention scoring system (TISS)…
Figure 2. Therapeutic intervention scoring system (TISS) distribution
Figure 3. Acute physiology score (APS) distribution
Figure 3. Acute physiology score (APS) distribution
Figure 4. Acute physiology score (APS) and…
Figure 4. Acute physiology score (APS) and mean therapeutic intervention scoring system (TISS) distribution
Figure 5. Observed and predicted therapeutic intervention…
Figure 5. Observed and predicted therapeutic intervention scoring system (TISS) for peripheral vascular surgery
Figure 6. Observed and predicted cost
Figure 6. Observed and predicted cost

References

    1. Amos RJ, Amess JAL, Hinds CJ, Mollin DL. Incidence and pathogenesis of acute megaloblastic bone-marrow change in patients receiving intensive care. Lancet. 1982;11:835–838.
    1. Bunker JP, Fowles J. U.S. Congress, Office of Technology Assessment. Appendix F in Strategies for Medical Technology Assessment. Washington: U.S. Government Printing Office; Sept. 1982. Model for an institute for health care evaluation. OTA-8-181.
    1. Campbell DT, Stanley JC. Experimental and Quasi-Experimental Designs for Research. Rand McNally & Company; 1963.
    1. Coulton C, McClish D, Doremus H, et al. Implications of DRG's for intensive care. Crit Care Med. 1984;12(3):332. Abstract.
    1. Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic intervention scoring system: A method for quantitative comparison of patient care. Crit Care Med. 1974;2:57–60.
    1. Draper EA, Wagner DP, Knaus WA. Office of Research, Demonstrations, and Statistics, Health Care Financing Administration. Health Care Financing Review. 2. Vol. 3. Washington: U.S. Government Printing Office; Dec. 1981. The use of intensive care: A comparison of a university and community hospital. HCFA Pub. No. 03139.
    1. Feinstein AR. An additional basic science for clinical medicine I: The constraining fundamental paradigms. Ann Intern Med. 1983;99:393–397.
    1. Feller I, Tholen D, Cornell RG. Improvements in burn care, 1965 to 1979. JAMA. 1980;244:2074–2078.
    1. Finkler SA. The distinction between cost and charges. Ann Intern Med. 1982;96:102–109.
    1. Fuchs R, Scheidt S. Improved criteria for admission to cardiac care units. JAMA. 1981;246:2037–2041.
    1. Garber AM, Fuchs VR, Silverman JF. Case mix, costs, and outcomes: Differences between faculty and community services in a university hospital. N Engl J Med. 1984;310:1231–1237.
    1. Goldman L, Weinberg M, Weisberg M, et al. A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. N Engl J Med. 1982;307:588–596.
    1. Horn SD. Measuring severity of illness: Comparisons across institutions. Am J Public Health. 1983;73:25–31.
    1. Killip T. Problems in myocardial infarction. In: Ruseck HI, Zohman BL, editors. Coronary Heart Disease. Philadelphia: J. B. Lippincott Co.; 1972.
    1. Knaus WA, Zimmerman JE, Wagner DP, et al. APACHE—Acute physiology and chronic health evaluation: A physiologically based classification system. Crit Care Med. 1981;9:591–597.
    1. Knaus WA, Draper EA, Wagner DP, et al. Evaluating outcome from intensive care: A preliminary multihospital comparison. Crit Care Med. 1982;10:491–496.
    1. Knaus WA, Le Gall JR, Wagner DP, et al. A comparison of intensive care in the U.S.A. and France. Lancet. 1982;11:642–646.
    1. Knaus WA, Draper EA, Wagner DP. The use of intensive care: New research initiatives and their implications for national health policy. Milbank Memorial Fund Quarterly. 1983;61:561–583.
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A Severity of Disease Classification System for Acutely Ill Patients. 1984a Submitted for publication.
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An Evaluation of Outcome from Intensive Care. 1984b Submitted for publication.
    1. Kurek T, Zaloga GP, Chernow B, et al. Total serum T4 concentration correlates with severity of illness (APACHE score) in critically ill euthyroid patients. Clinical Research. 1984;32:251A. abstract.
    1. Lave JA. Hospital reimbursement under Medicare. Milbank Memorial Fund Quarterly. 1984;62:251–268.
    1. Mansfield E. Basic research and productivity increase in manufacturing. The American Economic Review. 1980;70:863–873.
    1. Meakins JL, Solomkin JS, Allo MD, et al. A proposed classification of intraabdominal infections: Stratification of etiology and risk, for future therapeutic trials. Archives of Surgery. 1984 To be published.
    1. Mulley AG, Thibault GE, Hughes RA, et al. The course of patients with suspected myocardial infarction: The identification of low-risk patients for early transfer from intensive care. N Engl J Med. 1980;302:943–948.
    1. Multnomah Foundation for Medical Care. Intensive Care Unit Areawide Study. Portland, OR: Multnomah Foundation for Medical Care; 1983.
    1. Pettengill J, Vertrees J. Office of Research and Demonstrations, Health Care Financing Administration. Health Care Financing Review. 2. Vol. 4. Washington: U.S. Government Printing Office; Dec. 1982. Reliability and validity in hospital case-mix measurement. HCFA Pub. No. 03149.
    1. Pozen MW, D'Agostino RB, Selker HP, et al. A predictive instrument to improve coronary care unit admission practices in acute ischemic heart disease: A prospective multicenter clinical trial. N Engl J Med. 1984;310:1273–1278.
    1. Relman AS. Assessment of Medical Practices. (Editorial) N Engl J Med. 1980;303:153–154.
    1. Roos NP, Roos LL. High and low surgical rates: Risk factors for area residents. Am J Public Health. 1981;71:591–600.
    1. U.S. General Accounting Office. Human Resources Division: Survey of the Use of Over Utilization of ICUs by Medicare Beneficiaries. Pilot Study. 1983
    1. Wagner DP, Knaus WA, Draper EA. Statistical validation of a severity of illness measure. Am J Public Health. 1983;73:878–884.
    1. Wagner DP, Knaus WA, Draper EA, Zimmerman JE. Identification of low-risk monitor patients within a medical-surgical intensive care unit. Med Care. 1983;21:425–434.
    1. Wagner DP, Wineland TD, Knaus WA. Office of Research and Demonstrations, Health Care Financing Administration. Health Care Financing Review. 1. Vol. 5. Washington: U.S. Government Printing Office; Sept. 1983. The hidden costs of treating severely ill patients: Charges and resource consumption in an intensive care unit. HCFA Pub. No. 03154.
    1. Wennberg JE, Gittelsohn A. Small area variations in health care delivery. Science. 1973;18:1102–1108.
    1. Wennberg JE, McPherson K, Caper P. Will payment based on diagnosis-related groups control hospital costs? N Engl J Med. 1984;331:295–300.
    1. Williams SV, Finkler SA, Murphy CM, Eisenberg JM. Improved cost allocation in case-mix accounting. Med Care. 1982;20:450–459.
    1. Yeh TS, Pollack MM, Ruttimann UE, et al. Validation of a physiologic stability index for use in critically ill infants and children. Pediatr Res. 1984 May;
    1. Young WW, Swinkola RB, Zorn DM. The measurement of hospital case mix. Med Care. 1982;20:501–512.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit