Measuring the Cost of Care Using Patient Management Categories. Volume 1. Patient Management Categories

摘要

The report describes a method of measuring the relative cost of hospital care for clinically defined patient types. The clinically-based case mix system was designed to permit comparative hospital cost analyses and to be used in hospital payment systems. The system is also useful for institutional planning, utilization review, and quality assessment. The patient classification consists of 800 'Patient Management Categories' (PMCs) that define nearly all patients in general acute-care hospitals. After a panel of physicians defined patient types clinically, the researchers mapped International Classification of Disease codes (ICD-9-CM) to the resultant patient types. The researchers then used diagnosis and procedure codes and other patient data to computerize the assignment of patients to PMCs. The PMC system can be applied to any database that is compatable with the Uniform Hospital Discharge Data Set (UHDDS). The variables used by the classification software include five diagnoses, three procedures, age, and sex. The PMC system also permits multiple assignments to different disease groups, thus identifying comorbid conditions. A patient can be assigned to a maximum of five PMCs.