Abstract
BackgroundSeverity of illness is an omnipresent confounder in health services research. Resource consumption can be applied as a proxy of severity. The most commonly cited hospital resource consumption measure is the case mix index (CMI) and the best-known illustration of the CMI is the Diagnosis Related Group (DRG) CMI used by Medicare in the U.S. For countries that do not have DRG type CMIs, the adjustment for severity has been troublesome for either reimbursement or research purposes. The research objective of this study is to ascertain the construct validity of CMIs derived from International Classification of Diseases (ICD) in comparison with DRG CMI.MethodsThe study population included 551 acute care hospitals in Taiwan and 2,462,006 inpatient reimbursement claims. The 18th version of GROUPER, the Medicare DRG classification software, was applied to Taiwan's 1998 National Health Insurance (NHI) inpatient claim data to derive the Medicare DRG CMI. The same weighting principles were then applied to determine the ICD principal diagnoses and procedures based costliness and length of stay (LOS) CMIs. Further analyses were conducted based on stratifications according to teaching status, accreditation levels, and ownership categories.ResultsThe best ICD-based substitute for the DRG costliness CMI (DRGCMI) is the ICD principal diagnosis costliness CMI (ICDCMI-DC) in general and in most categories with Spearman's correlation coefficients ranging from 0.938-0.462. The highest correlation appeared in the non-profit sector. ICD procedure costliness CMI (ICDCMI-PC) outperformed ICDCMI-DC only at the medical center level, which consists of tertiary care hospitals and is more procedure intensive.ConclusionThe results of our study indicate that an ICD-based CMI can quite fairly approximate the DRGCMI, especially ICDCMI-DC. Therefore, substituting ICDs for DRGs in computing the CMI ought to be feasible and valid in countries that have not implemented DRGs.
Highlights
Severity of illness is an omnipresent confounder in health services research
The ICDCMI-PL ranged from 0.32 to 1.63. Another phenomenon worth noting is that the averages of case mix index (CMI) are found to be in the following descending order across the board: medical centers, regional hospitals, local hospitals and non-accredited hospitals
The distributions of none of these CMIs were normal according to the one sample Kolmogorov-Smirnov (K-S) test
Summary
Severity of illness is an omnipresent confounder in health services research. Severity of illness is an omnipresent confounder in any study of patient outcomes or of the effectiveness of medical care. The severity of each individual patient is assessed independently based upon clinical findings and personal characteristics, which are mostly extracted from medical records; whereas hospital severity of illness describes the aggregate difficulty in the treatment of the diseases presenting themselves at each hospital as compared to other hospitals and most of the information utilized for this purpose comes from administrative data. What we are interested in, from the perspective of healthcare system management and health service research, is how the aggregate severity of illness at the hospital level can be derived from the administrative data
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