Disease staging classification system.
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Diagnosis-Related Groups↗
Biomedical subjects
D Z Louis
Publications and source records attributed to D Z Louis.
Disease staging. Applications for utilization review and quality assurance.
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Diagnosis-Related Groups↗
Staging of disease. A case-mix measurement.
Measurement of illness severity is required to evaluate diagnostic efficiency of physicians, assess quality of care, understand utilization of health services, design clinical trials, and reimburse hospitals on the basis of output. "Staging" is a method for measuring severity of specific, well-defined diseases. Staging defines discrete points in the course of individual diseases that are clinically detectable, reflect severity in terms of risk of death or residual impairment, and possess clinical significance for prognosis and choice of therapeutic modality. Medical staging criteria have been developed for 420 diagnoses and converted into "coded" criteria for the major diagnostic coding systems. Coded criteria can be efficiently applied to computerized hospital discharge abstracts to derive a comprehensive case-mix classification system. Uses of staging in epidemiologic, case-mix, and utilization analyses are illustrated for diabetes mellitus.
Adult↗
Disease staging: implications for hospital reimbursement and management.
The current patient classification schemes used in case-mix reimbursement are not fully sensitive to variations in resource consumption that are associated with differential disease severity. Disease staging is a clinically based measure of severity that uses objective medical criteria to assess the stage of disease progression. Its availability in automated form increases its ease of implementation in hospital reimbursement and management. Results of recent studies demonstrate that staging is a useful case-mix reimbursement and management tool that explains significant variation in cost per discharge within current diagnosis-related groups.
Costs and Cost Analysis↗
A comment on "domain of practice and the quality of physician performance".
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Clinical Competence↗
Evaluating inpatient costs: the staging mechanism.
Inpatient records at a short-term hospital over two years were analyzed according to the stage or degree of severity of their discharge diagnosis to examine their utilization of services. Patients with a more severe disease stage for surgical and medical conditions generated substantially higher total charges, ancillary charges, and had longer lengths of stay. At the 75th percentile (representing that value at which three-quarters of the cases fall below it in magnitude), increases in total charges from Stage I to II for ulcer of stomach, appendicitis, and diverticulitis were 103, 168, and 110 per cent, respectively. Ancillary charges for these diseases showed even greater increases, 167, 200, and 160 per cent, respectively. Components of ancillary charges revealed similar trends. The results suggest that a twofold review mechanism incorporating length of stay and charges, using the staging technique, would make the review procedure more discriminating in identifying cases appropriate for review.
Costs and Cost Analysis↗
The staging concept--an approach to the assessment of outcome of ambulatory care.
The paper describes a method to evaluate patient care. The technique is based on the staging concept. Its basic premise is that the seriousness of a patient's condition at some point in the treatment process is a good indicator of the outcome of the previous parts of the process. Data were collected for 5,000 patients who had been admitted to a sample of hospitals in two California cities with a primary diagnosis matching one of the diseases for which staging criteria had been developed. The results indicate that the staging technique can be used to distinguish between the outcomes of ambulatory care received by different population groups.
Ambulatory Care↗
Health care plan decisions regarding preventive services.
BACKGROUND: Medical decisions previously made by physicians and patients are increasingly influenced by health plans. It is important to understand how these decisions are made and who makes them. OBJECTIVES: To determine protocols used by health plans for recommending preventive services and to identify methods used to develop these protocols. METHODS: An interviewer conducted semistructured telephone interviews with medical directors from 6 major types of health plans regarding coverage of certain procedural preventive services. Each medical director was asked: (1) Is this procedure paid for by the health plan? (2) What is the frequency recommended for this procedure? (3) What age groups do you recommend for this procedure? (4) Do you encourage patients to receive this procedure, and if so, how? (5) Who developed these preventive services recommendations? (6) How were these recommendations developed? RESULTS: Ten interviews were completed representing 6 chosen types of health plans. While the different plans varied little regarding the preventive services recommended, there was variation in efforts to promote recommended services to members. There were also differences among the plans in the decision-making process for developing preventive services recommendations. CONCLUSIONS: Managed care organizations promote certain preventive services to members. All health plans had at least 1 preventive medicine task force charged with making coverage decisions about preventive services. However, more could be done to rationalize development of preventive services recommendations, primarily, implementation of evidence-based guidelines.
Adult↗