Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement

This article describes the potential for the acute physiology score (APS) of acute physiology and chronic health evaluation (APACHE) II, to be used as a severity adjustment to diagnosis-related groups (DRG's) or other diagnostic classifications. The APS is defined by a relative value scale applied to 12 objective physiologic variables routinely measured on most hospitalized patients shortly after hospital admission. For intensive care patients, APS at admission is strongly related to subsequent resource costs of intensive care for 5,790 consecutive admissions to 13 large hospitals, across and within diagnoses. The APS could also be used to evaluate quality of care, medical technology, and the response to changing financial incentives.

[1]  R. G. Cornell,et al.  Improvements in burn care, 1965 to 1979. , 1980, JAMA.

[2]  S. Horn.  Facilities , 1983, American journal of public health.

[3]  L L Roos,et al.  High and low surgical rates: risk factors for area residents. , 1981, American journal of public health.

[4]  K. McPherson,et al.  Will payment based on diagnosis-related groups control hospital costs? , 1984, The New England journal of medicine.

[5]  J. Civetta,et al.  Therapeutic intervention scoring system: a method for quantitative comparison of patient care. , 1974, Critical care medicine.

[6]  D. Mollin,et al.  INCIDENCE AND PATHOGENESIS OF ACUTE MEGALOBLASTIC BONE-MARROW CHANGE IN PATIENTS RECEIVING INTENSIVE CARE , 1982, The Lancet.

[7]  D. Campbell,et al.  EXPERIMENTAL AND QUASI-EXPERIMENT Al DESIGNS FOR RESEARCH , 2012 .

[8]  J. Meakins,et al.  A proposed classification of intra-abdominal infections. Stratification of etiology and risk for future therapeutic trials. , 1984, Archives of surgery.

[9]  W. W. Young,et al.  The Measurement of Hospital Case Mix , 1982, Medical care.

[10]  Edwin Mansfield,et al.  Basic Research and Productivity Increase in Manufacturing , 1980 .

[11]  Jeffrey A. Stem,et al.  A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. , 1982, The New England journal of medicine.

[12]  G O Barnett,et al.  The course of patients with suspected myocardial infarction. The identification of low-risk patients for early transfer from intensive care. , 1980, The New England journal of medicine.

[13]  A. Gittelsohn,et al.  Small Area Variations in Health Care Delivery , 1973, Science.

[14]  W. Knaus,et al.  Identification of Low-Risk Monitor Patients Within a Medical-Surgical Intensive Care Unit , 1983, Medical care.

[15]  R B D'Agostino,et al.  A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. A prospective multicenter clinical trial. , 1984, The New England journal of medicine.

[16]  D. E. Lawrence,et al.  APACHE—acute physiology and chronic health evaluation: a physiologically based classification system , 1981, Critical care medicine.

[17]  U. Ruttimann,et al.  Validation of a Physiologic Stability Index for Use in Critically Ill Infants and Children , 1984, Pediatric Research.

[18]  J. Eisenberg,et al.  Improved Cost Allocation in Case-Mix Accounting , 1982, Medical care.

[19]  A. Feinstein.  An additional basic science for clinical medicine: I. The constraining fundamental paradigms. , 1983, Annals of internal medicine.

[20]  E. Draper,et al.  Evaluating outcome from Intensive care: A preliminary multihospital comparison , 1982, Critical care medicine.

[21]  A. Relman.  Assessment of medical practices: a simple proposal. , 1980, The New England journal of medicine.

[22]  S. Finkler.  The distinction between cost and charges. , 1982, Annals of internal medicine.

[23]  R. Fuchs,et al.  Improved criteria for admission to cardiac care units. , 1981, JAMA.

[24]  V. Fuchs,et al.  Case Mix, Costs, and Outcomes: Differences Between Faculty and Community Services in a University Hospital , 1984 .

[25]  W. Knaus,et al.  The Hidden Costs of Treating Severely 111 Patients: Charges and Resource Consumption in an Intensive Care Unit , 1983, Health care financing review.

[26]  J. Pettengill,et al.  Reliability and Validity in Hospital Case-Mix Measurement , 1982, Health care financing review.