Case Mix Groups Research Articles

Vancomycin-induced acute kidney injury in Hong Kong

To characterize rehabilitation outcomes of patients with severe poststroke motor impairment (MI) and develop a predictive model for treatment failure.Retrospective cohort study. Correlates of treatment failure, defined as the persistence of severe MI after rehabilitation, were identified using logistic regression analysis. Then, an integer-based scoring rule was developed from the logistic model.Three specialized inpatient rehabilitation facilities.Patients (N=1265) classified as case-mix groups (CMGs) 0108, 0109, and 0110 of the Medicare classification system.Not applicable.Change in the severity of MI, as assessed by the FIM, from admission to discharge.Median FIM-motor (FIM-M) score increased from 17 (interquartile range [IQR] 14-23) to 38 (IQR, 25-55) points. Median proportional recovery, as expressed by FIM-M effectiveness, was 26% (IQR, 12-47). Median FIM-M change was 18 (IQR, 9-34) points. About 38.5% patients achieved the minimal clinically important difference. Eighteen point six percent and 32.0% of the patients recovered to a stage of either mild (FIM-M ≥62) or moderate (FIM-M 38-61) MI, respectively. All between-CMG differences were statistically significant. Outcomes have also been analyzed according to classification systems used in Australia and Canada. The scoring rule had an area under the curve of 0.833 (95% confidence interval, 0.808-0.858). Decision curve analysis displayed large net benefit of using the risk score compared with the treat all strategy.This study provides a snapshot of rehabilitation outcomes in a large cohort of patients with severe poststroke MI, thus filling a gap in knowledge. The scoring rule accurately identified the patients at risk for treatment failure.

Medicare Outpatient Physical Therapy Expenditures Vary by Diagnosis and Functional Mobility.

Clinical characteristics driving variations in Medicare outpatient physical therapy expenditures are inadequately understood. The objectives of this study were to examine variations in annual outpatient physical therapy expenditures of Medicare fee-for-service beneficiaries by primary diagnosis and baseline functional mobility, and to assess whether case mix groups based on primary diagnosis and functional mobility scores would be useful for expenditure differentiation. This was an observational, longitudinal study. Volunteer providers in community settings participated in data collection with Continuity Assessment Record and Evaluation-Community (CARE-C) assessments for Medicare fee-for-service beneficiaries. Annual outpatient physical therapy expenditures were calculated using allowed charges on Medicare claims; primary diagnosis and baseline functional mobility were obtained from CARE-C assessments. Whether annual expenditures varied significantly across primary diagnosis groups and within diagnosis groups by functional mobility was examined. Data for 4210 patients (mean [SD] age = 72.9 [9.9] years; 64.6% women) from 127 providers were included. Mean expenditures differed significantly across 12 primary diagnosis groups created from CARE-C clinician-reported diagnoses (F = 12.73; df = 11). Twenty-five pairwise differences in 66 pairwise diagnosis group comparisons were statistically significant. Within 8 diagnosis groups, expenditures were significantly higher for low-mobility subgroups than for high-mobility subgroups; borderline significance was achieved for 1 diagnosis group. The small convenience sample limited the statistical power and the generalizability of the results. Significant variations in physical therapy expenditures based on primary diagnosis and baseline functional mobility support the use of these variables in predicting outpatient physical therapy expenditures. Although Medicare's annual therapy spending cap was repealed effective January 2018, the data from this study provide an initial foundation to inform any future policy efforts, such as targeted medical review, risk-adjusted therapy payments, or case mix groups as potential payment alternatives. Additional research with larger samples is needed to further develop and test case mix groups and improve generalizability to the national population. Refined case mix groups could also help providers prognosticate physical therapy expenditures based on patient profiles.

Rehabilitation Outcomes of Patients With Severe Disability Poststroke

ObjectiveTo characterize rehabilitation outcomes of patients with severe poststroke motor impairment (MI) and develop a predictive model for treatment failure. DesignRetrospective cohort study. Correlates of treatment failure, defined as the persistence of severe MI after rehabilitation, were identified using logistic regression analysis. Then, an integer-based scoring rule was developed from the logistic model. SettingThree specialized inpatient rehabilitation facilities. ParticipantsPatients (N=1265) classified as case-mix groups (CMGs) 0108, 0109, and 0110 of the Medicare classification system. InterventionsNot applicable. Main Outcome MeasureChange in the severity of MI, as assessed by the FIM, from admission to discharge. ResultsMedian FIM-motor (FIM-M) score increased from 17 (interquartile range [IQR] 14-23) to 38 (IQR, 25-55) points. Median proportional recovery, as expressed by FIM-M effectiveness, was 26% (IQR, 12-47). Median FIM-M change was 18 (IQR, 9-34) points. About 38.5% patients achieved the minimal clinically important difference. Eighteen point six percent and 32.0% of the patients recovered to a stage of either mild (FIM-M ≥62) or moderate (FIM-M 38-61) MI, respectively. All between-CMG differences were statistically significant. Outcomes have also been analyzed according to classification systems used in Australia and Canada. The scoring rule had an area under the curve of 0.833 (95% confidence interval, 0.808-0.858). Decision curve analysis displayed large net benefit of using the risk score compared with the treat all strategy. ConclusionsThis study provides a snapshot of rehabilitation outcomes in a large cohort of patients with severe poststroke MI, thus filling a gap in knowledge. The scoring rule accurately identified the patients at risk for treatment failure.

Investigating the effect of sociodemographic factors on 30-day hospital readmission among medical patients in Toronto, Canada: a prospective cohort study

ObjectiveTo examine the influence of patient-level sociodemographic factors on the incidence of hospital readmission within 30 days among medical patients in a large Canadian metropolitan city.DesignProspective cohort study.Setting and participantsPatients...

Capturing patients' needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems.

BackgroundContemporary casemix systems for health services need to ensure that payment rates adequately account for actual resource consumption based on patients’ needs for services. It has been argued that functioning information, as one important determinant of health service provision and resource use, should be taken into account when developing casemix systems. However, there has to date been little systematic collation of the evidence on the extent to which the addition of functioning information into existing casemix systems adds value to those systems with regard to the predictive power and resource variation explained by the groupings of these systems. Thus, the objective of this research was to examine the value of adding functioning information into casemix systems with respect to the prediction of resource use as measured by costs and length of stay.MethodsA systematic literature review was performed. Peer-reviewed studies, published before May 2014 were retrieved from CINAHL, EconLit, Embase, JSTOR, PubMed and Sociological s using keywords related to functioning (‘Functioning’, ‘Functional status’, ‘Function*, ‘ICF’, ‘International Classification of Functioning, Disability and Health’, ‘Activities of Daily Living’ or ‘ADL’) and casemix systems (‘Casemix’, ‘case mix’, ‘Diagnosis Related Groups’, ‘Function Related Groups’, ‘Resource Utilization Groups’ or ‘AN-SNAP’). In addition, a hand search of reference lists of included articles was conducted. Information about study aims, design, country, setting, methods, outcome variables, study results, and information regarding the authors’ discussion of results, study limitations and implications was extracted.ResultsTen included studies provided evidence demonstrating that adding functioning information into casemix systems improves predictive ability and fosters homogeneity in casemix groups with regard to costs and length of stay. Collection and integration of functioning information varied across studies. Results suggest that, in particular, DRG casemix systems can be improved in predicting resource use and capturing outcomes for frail elderly or severely functioning-impaired patients.ConclusionFurther exploration of the value of adding functioning information into casemix systems is one promising approach to improve casemix systems ability to adequately capture the differences in patient’s needs for services and to better predict resource use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1277-x) contains supplementary material, which is available to authorized users.

Development of Professionalism and Performance Accountability for Sustained FIM Accuracy Improvement.

Rehabilitation nurses have essential responsibility for detailed Functional Independence Measure (FIM) documentation and accurate scoring. The goal of this performance improvement project was to improve individual FIM accuracy and establish and maintain a FIM accuracy standard. Case Study. This performance improvement project was implemented in a 20-bed CARF-accredited Midwestern acute care hospital inpatient rehabilitation unit. Improved individual and overall RN FIM scoring accuracy, with increased length of stay and case mix index. Concurrent FIM scoring and documentation review holds staff accountable and allows for timely revisions following discrepancy identification. Leadership supports for concurrent FIM audits, utilization of available technology, transparent reporting of results, and individual accountability lead to sustained improvement in FIM scoring accuracy. Accurate FIM documentation and scoring drive appropriate length of stay and case mix group assignment. Assessment competence enhances nursing engagement, confidence, and process accountability.

Impact of an innovative inpatient patient navigator program on length of stay and 30-day readmission.

The current climate of increasing patient complexity coupled with rising costs have prompted the need for adaptive innovation. There are limited data describing inpatient interventions targeting improvements in both communication and transitional care. Evaluate the patient navigator (PN) program, an innovative inpatient intervention intended to enhance navigation through the complexity of hospital admissions for patients and providers. PNs were dedicated patient-care facilitators without clinical responsibilities integrated as full members of the inpatient care team responsible for enhancing communication between and among patients and providers. Observational retrospective cohort study. All patients admitted to the general medical service between July 2010 and March 2014. Academic medical center. Primary outcomes were hospital length of stay (LOS) and 30-day readmission rate matched by case mix group, age category, and resource intensity weight. Our matched cohort included 5628 admissions (4592 patients) exposed and 2213 admissions (1920 patients) not exposed to PNs. Admissions with PNs were 1.3 days (21%) shorter than admission without PNs (6.2 vs 7.5 days, P < 0.001). Thirty-day readmission rate was not different between the 2 groups (13.1 vs 13.8%, P = 0.48). Implementation of this intervention was associated with a reduction in LOS without an increase in 30-day readmission.

Inter-rater reliability of a computerized presenting-complaint-linked triage system in an urban emergency department.

Triage reliability studies typically use hypothetical scenarios and weighted kappa scores where agreement within one level is considered satisfactory. But if triage category is used to help define ED case-mix groups for comparative or benchmarking processes, agreement on exact triage level and major system involved is important. Our hypothesis was that a computerized menu that links presenting complaints to preferred triage levels (PC-linked triage) would provide high triage reliability. Our objective was to assess inter-rater reliability of PC-linked triage using the Canadian Emergency Department Triage and Acuity Scale (CTAS) in a real-time clinical setting, considering agreement on exact triage level and primary body system involved. On duty triage nurses entered patient presenting complaint and PC-linked triage level as per standard procedure. In a convenience sample of patients, a second nurse, blinded to triage assignment, observed the triage interaction and independently entered presenting complaint and triage level on a dummy terminal. During the study, 15 nurse pairs triaged 266 patients. Study patients matched actual emergency department case mix closely. Triage nurses agreed exactly in 74% of cases and within one level in 94% of cases. The unweighted kappa value was 0.66 (95% confidence interval [CI], 0.60-0.73) and the quadratic weighted kappa value was 0.75 (95% CI, 0.68-0.81). Kappa for agreement on major system involved was 0.80 (95% CI, 0.69-0.91). PC-linked triage has high inter-rater reliability in a real-time clinical setting. PC-linked triage may be useful as one factor in defining case-mix groups for benchmarking and comparative purposes.

Evaluating Siebens Domain Management Model for Inpatient Rehabilitation to Increase Functional Independence and Discharge Rate to Home in Geriatric Patients

ObjectiveTo evaluate the Siebens Domain Management Model (SDMM) for geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home. DesignBefore and after study. SettingIR facility. ParticipantsDuring 2010 (preintervention), 429 patients aged ≥75 years who were on average admitted to IR 8.2 days postacute care, and during 2012 (postintervention), 524 patients aged ≥75 years who were on average admitted to IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity, preadmission living setting, and living support were similar in both groups. InterventionThe SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home. Main Outcome MeasuresFIM efficiency, length of stay (LOS), and disposition rates to community/home, acute care, and long-term care (LTC) to compare pre-/postintervention facility data and comparison of facility to national CMG-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012). ResultsPre-/postintervention group admission FIM scores were similar (t=2.96, P<.003), but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a significant difference (t=4.1, P<.0001). There were significantly more discharges to the community in the postintervention group (74.4%) than the preintervention group (58.5%, χ2=26.2, P<.0001). There were significantly fewer patients discharged to LTC in the postintervention group (χ2=30.47, P<.0001). The preintervention group did not significantly differ from the 2010 national data, but the postintervention group significantly differed from the 2012 national data for both greater FIM efficiency (t=−5.5, P<.0001) and greater discharge to community (χ2=34, P<.0001). LOS decreased by 2.6 days in the postintervention group compared with the preintervention group, whereas LOS decreased by only 0.6 days nationally from 2010 to 2012, a significant difference with postintervention LOS lower than the national data (t=31.1, P<.0001). ConclusionsUse of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.

Measure of Functional Independence Dominates Discharge Outcome Prediction After Inpatient Rehabilitation for Stroke

Identifying clinical data acquired at inpatient rehabilitation admission for stroke that accurately predict key outcomes at discharge could inform the development of customized plans of care to achieve favorable outcomes. The purpose of this analysis was to use a large comprehensive national data set to consider a wide range of clinical elements known at admission to identify those that predict key outcomes at rehabilitation discharge. Sample data were obtained from the Uniform Data System for Medical Rehabilitation data set with the diagnosis of stroke for the years 2005 through 2007. This data set includes demographic, administrative, and medical variables collected at admission and discharge and uses the FIM (functional independence measure) instrument to assess functional independence. Primary outcomes of interest were functional independence measure gain, length of stay, and discharge to home. The sample included 148,367 people (75% white; mean age, 70.6±13.1 years; 97% with ischemic stroke) admitted to inpatient rehabilitation a mean of 8.2±12 days after symptom onset. The total functional independence measure score, the functional independence measure motor subscore, and the case-mix group were equally the strongest predictors for any of the primary outcomes. The most clinically relevant 3-variable model used the functional independence measure motor subscore, age, and walking distance at admission (r(2)=0.107). No important additional effect for any other variable was detected when added to this model. This analysis shows that a measure of functional independence in motor performance and age at rehabilitation hospital admission for stroke are predominant predictors of outcome at discharge in a uniquely large US national data set.

Development of MY-DRG casemix pharmacy service weights in UKM Medical Centre in Malaysia.

BackgroundThe service weight is among several issues and challenges in the implementation of case-mix in developing countries, including Malaysia. The aim of this study is to develop the Malaysian Diagnosis Related Group (MY-DRG) case-mix pharmacy service weight in University Kebangsaan Malaysia-Medical Center (UKMMC) by identifying the actual cost of pharmacy services by MY-DRG groups in the hospital.MethodsAll patients admitted to UKMMC in 2011 were recruited in this study. Combination of Step-down and Bottom-up costing methodology has been used in this study. The drug and supplies cost; the cost of staff; the overhead cost; and the equipment cost make up the four components of pharmacy. Direct costing approach has been employed to calculate Drugs and supplies cost from electronic-prescription system; and the inpatient pharmacy staff cost, while the overhead cost and the pharmacy equipments cost have been calculated indirectly from MY-DRG data base. The total pharmacy cost was obtained by summing the four pharmacy components’ cost per each MY-DRG. The Pharmacy service weight of a MY-DRG was estimated by dividing the average pharmacy cost of the investigated MY-DRG on the average of a specified MY-DRG (which usually the average pharmacy cost of all MY-DRGs).ResultsDrugs and supplies were the main component (86.0%) of pharmacy cost compared o overhead cost centers (7.3%), staff cost (6.5%) and pharmacy equipments (0.2%) respectively. Out of 789 inpatient MY-DRGs case-mix groups, 450 (57.0%) groups were utilized by the UKMMC. Pharmacy service weight has been calculated for each of these 450 MY-DRGs groups. MY-DRG case-mix group of Lymphoma & Chronic Leukemia group with severity level three (C-4-11-III) has the highest pharmacy service weight of 11.8 equivalents to average pharmacy cost of RM 5383.90. While the MY-DRG case-mix group for Circumcision with severity level one (V-1-15-I) has the lowest pharmacy service weight of 0.04 equivalents to average pharmacy cost of RM 17.83.ConclusionA mixed approach which is based partly on top-down and partly on bottom up costing methodology has been recruited to develop MY-DRG case-mix pharmacy service weight for 450 groups utilized by the UKMMC in 2011.

ICHI Categorial Structure: a WHO-FIC Tool for Semantic Interoperability of Procedures Classifications.

Casemix grouping using procedures classifications has become an important use case for health care terminologies. There are so many different national procedures classifications used for Casemix grouping that it is not possible to agree on a worldwide standard. ICHI (International Classification of Health Interventions) is proposing an approach that standardises only the terminologies' model structure. The poster shows the use of the ICHI alpha to replace ICD9 CM Volume 3 in the UNU-CBG International Casemix grouper.

Using Business Intelligence to Analyze and Share Health System Infrastructure Data in a Rural Health Authority

BackgroundHealth care organizations gather large volumes of data, which has been traditionally stored in legacy formats making it difficult to analyze or use effectively. Though recent government-funded initiatives have improved the situation, the quality of most existing data is poor, suffers from inconsistencies, and lacks integrity. Generating reports from such data is generally not considered feasible due to extensive labor, lack of reliability, and time constraints. Advanced data analytics is one way of extracting useful information from such data.ObjectiveThe intent of this study was to propose how Business Intelligence (BI) techniques can be applied to health system infrastructure data in order to make this information more accessible and comprehensible for a broader group of people.MethodsAn integration process was developed to cleanse and integrate data from disparate sources into a data warehouse. An Online Analytical Processing (OLAP) cube was then built to allow slicing along multiple dimensions determined by various key performance indicators (KPIs), representing population and patient profiles, case mix groups, and healthy community indicators. The use of mapping tools, customized shape files, and embedded objects further augment the navigation. Finally, Web forms provide a mechanism for remote uploading of data and transparent processing of the cube. For privileged information, access controls were implemented.ResultsData visualization has eliminated tedious analysis through legacy reports and provided a mechanism for optimally aligning resources with needs. Stakeholders are able to visualize KPIs on a main dashboard, slice-and-dice data, generate ad hoc reports, and quickly find the desired information. In addition, comparison, availability, and service level reports can also be generated on demand. All reports can be drilled down for navigation at a finer granularity.ConclusionsWe have demonstrated how BI techniques and tools can be used in the health care environment to make informed decisions with reference to resource allocation and enhancement of the quality of patient care. The data can be uploaded immediately upon collection, thus keeping reports current. The modular design can be expanded to add new datasets such as for smoking rates, teen pregnancies, human immunodeficiency virus (HIV) rates, immunization coverage, and vital statistical summaries.

Falls in hospital increase length of stay regardless of degree of harm.

Acute inpatient falls are common and serious adverse events that lead to injury, prolonged hospitalization and increased cost of care. To determine the difference in total acute hospital care length of stay (LOS) for patients with and without an in-hospital fall (IHF), regardless of degree of harm. This was a retrospective observational study at a 728-bed acute care teaching hospital. We used propensity scores to match 292 patients with 330 controls by case mix group, sex, Resource Intensity Weights and week of admission. We used two administrative databases: hospital fall incident reporting system and Discharge Abstract Database. We reviewed all IHF incidents for patients 18 years and older, admitted to inpatient acute care hospital units/programs between 1 November 2009 and 31 August 2011. The average LOS for IHF cases was 37.2 days [median 26.5 days; interquartile range (IQR) 14, 54] and 25.7 days (median 13 days; IQR 5, 33) for matched control patients. Survival analysis results indicated that patients who did not have an IHF were 2.4 times (95% CI 2.1, 2.7; P < 0.001) more likely to be discharged earlier from acute care than patients who had an IHF. Experiencing either an injurious or a non-injurious fall during an acute care hospitalization was associated with prolonged LOS.

Specialty use among patients with treated hypertension in a patient-centered medical home.

Little is known about how delivery of primary care in the patient-centered medical home (PCMH) influences outpatient specialty care use. To describe changes in outpatient specialty use among patients with treated hypertension during and after PCMH practice transformation. One-group, 48-month interrupted time series across baseline, PCMH implementation and post-implementation periods. Adults aged 18-85 years with treated hypertension. System-wide PCMH redesign implemented across 26 clinics in an integrated health care delivery system, beginning in January 2009. Resource Utilization Band variables from the Adjusted Clinical Groups case mix software characterized overall morbidity burden (low, medium, high). Negative binomial regression models described adjusted annual differences in total specialty care visits. Poisson regression models described adjusted annual differences in any use (yes/no) of selected medical and surgical specialties. Compared to baseline, the study population averaged 7% fewer adjusted specialty visits during implementation (P < 0.001) and 4% fewer adjusted specialty visits in the first post-implementation year (P = 0.02). Patients were 12% less likely to have any cardiology visits during implementation and 13% less likely during the first post-implementation year (P < 0.001). In interaction analysis, patients with low morbidity had at least 27% fewer specialty visits during each of 3 years following baseline (P < 0.001); medium morbidity patients had 9% fewer specialty visits during implementation (P < 0.001) and 5% fewer specialty visits during the first post-implementation year (P = 0.007); high morbidity patients had 3% (P = 0.05) and 5% (P = 0.009) higher specialty use during the first and second post-implementation years, respectively. Results suggest that more comprehensive primary care in this PCMH redesign enabled primary care teams to deliver more hypertension care, and that many needs of low morbidity patients were within the scope of primary care practice. New approaches to care coordination between primary care teams and specialists should prioritize high morbidity, clinically complex patients.

Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation.

The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research.

Web based application for Casemix Grouper (Online Casemix Grouper)

Background Casemix Grouper software is a tool to improve efficiency and quality of care in hospitals and medical centres. The utilisation of Casemix Grouper among hospitals is very limited and depends on their existing local machine and hardware. While Casemix Grouper provides a crucial output in the form of Casemix groups, the hardware machine should not be a limiting factor to hospital. Thus, the objective of this development was to provide the utility for end user to use the Casemix Grouper on web environment.

THE ROLE OF HEALTH INFORMATION MANAGEMENT PROFESSIONALS IN THE IMPELENTATION OF INA-CBGs IN BLUD RSU H. BOEJASIN PELAIHARI

ABSTRACT Backgrounds:Jamkesmas refers to medical assistance program designed to meet the needs of low income people which is funded by the federal goverment. The prospective payment systems is adopted as payment method is called an Indonesia Case Based Groups (INA-CBGs). In an INA-CBGs, an accurate and complete clinical data is required. While the primary function of health information department is providing that an accurate and complete clinical data for billing, In BLUD RSU H. Boejasin Pelaihari, HIM professional is not exist yet so provide clinical data for billing is carried out by other health workforce. No one of coders' process for review of clinical data, the billing process, and the payers' reimbursement to the healthcare facilities. Objectives: This study aims toinvestigate the role ofhealth informationmanagement professionals in INA­CBGs implementation Methods: This descriptive research study was performed to describe INA-CBGs implementation. The study population all of the health workforce involve in INA-CBGs implementation, sample are coder and independent verificator. An interview guide and checklist were used as instrument for observation and interview. Results: On the flow and procedures of INA-CBGs reimbursement process shows redundancy verification at claim document so take long times claim process. The three activities include data entry, grouping and recapitulation to be done of two health workforces, they are should be only done one health workforce.The eleven workforces in case-mix group member include hospital director, the head of services, the physicians, the head of medical record department, pharmacistand the services staff. Coded Diagnosis and procedures data is verified by independent verificator, whose not member of case-mix group. It is should not be needed, that is primary function of health information department or medical record department for providing accurate and complete clinical data for billing. The role a HIM professional are increase revenue potential by assuring accurate coding supported by documentation, improved cash flow by first time processing with few denials and appeals required etc.No case-mix team and no expenditure for them. Keywords: Health Information Management (HIM), HIM Professional, INA-CBGs, Medical Record, Reimbursement Process, Coder

Development of a case-mix funding system for adults with combined vision and hearing loss

BackgroundAdults with vision and hearing loss, or dual sensory loss (DSL), present with a wide range of needs and abilities. This creates many challenges when attempting to set the most appropriate and equitable funding levels. Case-mix (CM) funding models represent one method for understanding client characteristics that correlate with resource intensity.MethodsA CM model was developed based on a derivation sample (n = 182) and tested with a replication sample (n = 135) of adults aged 18+ with known DSL who were living in the community. All items within the CM model came from a standardized, multidimensional assessment, the interRAI Community Health Assessment and the Deafblind Supplement. The main outcome was a summary of formal and informal service costs which included intervenor and interpreter support, in-home nursing, personal support and rehabilitation services. Informal costs were estimated based on a wage rate of half that for a professional service provider ($10/hour). Decision-tree analysis was used to create groups with homogeneous resource utilization.ResultsThe resulting CM model had 9 terminal nodes. The CM index (CMI) showed a 35-fold range for total costs. In both the derivation and replication sample, 4 groups (out of a total of 18 or 22.2%) had a coefficient of variation value that exceeded the overall level of variation. Explained variance in the derivation sample was 67.7% for total costs versus 28.2% in the replication sample. A strong correlation was observed between the CMI values in the two samples (r = 0.82; p = 0.006).ConclusionsThe derived CM funding model for adults with DSL differentiates resource intensity across 9 main groups and in both datasets there is evidence that these CM groups appropriately identify clients based on need for formal and informal support.

Association of Various Comorbidity Measures With Spinal Cord Injury Rehabilitation Outcomes

ObjectiveTo investigate the amount of variation in short- and medium-term spinal cord injury (SCI) rehabilitation outcomes explained by various comorbidity measures, over and above patient preinjury characteristics and neurologic and functional status. DesignProspective observational cohort study of traumatic SCI patients receiving inpatient rehabilitation and followed up at 1 year postinjury. SettingInpatient rehabilitation and community follow-up at 6 SCI treatment centers. ParticipantsParticipants (N=1376) included 1032 patients randomly selected for model development and 344 patients selected for cross-validation. InterventionsNot applicable. Main Outcome MeasuresRehabilitation length of stay (LOS), return to acute care during rehabilitation, discharge motor FIM, discharge home, rehospitalization after discharge, 1-year return to work/school and 1-year depression symptomatology, motor FIM, and residence. Comorbidity measures used were case-mix groups tier weights, Charlson Comorbidity Index (CCI), and the Comprehensive Severity Index (CSI). ResultsMultivariable regression analyses, controlling for patient preinjury and injury characteristics, found that the maximum Comprehensive Severity Index (MCSI) was a significant and stronger predictor of LOS, return to acute care during rehabilitation, and 1-year motor FIM compared with the case-mix groups tier weight or the CCI. The admission CSI was a strong predictor of LOS. For rehospitalization after discharge, only the case-mix groups tier weight was significant. No comorbidity measure was significant beyond patient preinjury and injury characteristics for discharge home, discharge motor FIM, living at home, depression symptomatology, major depressive syndrome, and return to work/school. ConclusionsPatient preinjury and injury characteristics are sufficient to predict most SCI outcomes. For rehabilitation LOS and return to acute care during rehabilitation, one achieves substantially better explanation when taking clinical comorbidity based on the MCSI into account.