title: All patient refined-diagnostic related group and case mix index in acute care palliative medicine.
abstract: The All Patient Refined-Diagnostic Related Group (APR-DRG) is a modification of the traditional DRG that adds four classes of illness severity and four classes of mortality risk. The APR-DRG is a more accurate assessment of the complexity of care. When individuals with advanced illness are admitted to an acute inpatient palliative medicine unit, there may be a perception that they receive less intense acute care. Most of these patients, however, are multisymptomatic, have several comorbidities, and are older. For all patients admitted to the unit, a guide was followed by staff physicians to document clinical information that included the site(s) of malignancy, site(s) of metastases, disease complications, disease-related symptoms, and comorbidities. We then prospectively compared DRGs, APR-DRGs, and case mix index (CMI) from January 1-June 30, 2003, and February 1-July 31,2004, before and after the use of the guide. The overall mean severity of illness (ASOI) increased by 25% (P < 0.05). The mean CMI increased by 12% (P < 0.05). The average length of stay over the same period increased slightly from 8.97 to 9.56 days. Systematic documentation of clinical findings using a specific tool for patients admitted to an acute inpatient palliative medicine unit based on APR-DRG classifications captured a higher severity of illness and may better reflect resource utilization.
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Lagman
authors.forename: Declan
authors.initials: D
authors.lastname: Walsh
authors.forename: Mellar P
authors.initials: MP
authors.lastname: Davis
authors.forename: Brett
authors.initials: B
authors.lastname: Young
mesh_terms: D003953:Diagnosis-Related Groups; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D009369:Neoplasms / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care; D010343:Patient Admission; D010820:Physicians; D011446:Prospective Studies; D020379:Risk Adjustment; D012720:Severity of Illness Index