APACHE-L: A New Severity of Illness Adjuster for Inpatient Medical Care
APACHE-L: A New Severity of Illness Adjuster for Inpatient Medical Care
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APACHE-L：用于住院医疗护理的新型疾病严重程度调整器
DOI：
10.1097/00005650-199205000-00006
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发表时间：
1992
期刊：
影响因子：
3
通讯作者：
L. Weissfeld
中科院分区：
文献类型：
--
作者：
L. McMahon;R. Hayward;A. Bernard;J. Rosevear;L. Weissfeld
关于医疗保险的诊断相关组（DRG）为基础的前瞻性支付系统的一个主要问题是，医院照顾更严重的病人是否可能补偿不足，他们提供的服务。由于缺乏一个客观的、容易获得的、有效的衡量病人病情严重程度的方法，对医院支付中可能存在的不公平现象的研究受到了阻碍。由于实验室数据是客观的，在我们国家的大多数医院，利用这些数据的系统，如果显示出不同的预期资源使用的患者之间的区别，可以证明是最有帮助的，在未来的支付系统医院支付检查可能的不公平。在一家主要的教学医院，使用美国10个最常见的医疗DRG中住院时间的数据来开发和评估疾病严重程度系统APACHE-L。APACHE-L使用原始APACHE评分的实验室组成部分。DRGs解释了前十名DRGs住院时间变化的20%，而APACHE-L解释了另外14%的变化。对于辅助资源使用，DRG解释了10%的方差，APACHE-L解释了高达15%的方差。诊断相关组特异性分析表明，APACHE-L解释的资源使用差异量因DRG而异（从DRG 410，化疗的R2=.00;到DRG 320，肾脏和尿路感染，年龄> 17岁，并发症或合并症的R2=.38）。APACHE-L评分，这是客观的，在我们国家的医院容易获得，显示出相当大的承诺，作为一个疾病的严重程度调整的一个子集的DRG。
A principal concern regarding Medicare's diagnosis-related group (DRG)-based prospective payment system is whether hospitals caring for more severely ill patients may be undercompensated for the services they provide. Research on possible inequities in hospital payment has been hampered by the absence of an objective, easily obtained, and valid measure of patients' severity of illness. Because laboratory data are objective and computerized in most of our nation's hospitals, a system utilizing such data, if shown to discriminate between patients of differing expected resource use, could prove most helpful in examining possible inequities in prospective payment system hospital payment. At a major teaching hospital, data were used from length of stay inlier patients in the 10 most frequent medical DRGs in the U.S. to develop and evaluate a severity of illness system called APACHE-L. APACHE-L uses the laboratory component of the original APACHE score. Whereas DRGs explained 20% of the variation in length of stay for the top ten DRGs, APACHE-L explained up to an additional 14% of the variation. For ancillary resource use, DRGs explained 10% of the variance, and APACHE-L explained up to an additional 15%. Diagnosis-related group-specific analyses demonstrated that the amount of resource use variance explained by APACHE-L varied widely depending on the DRG (from R2=.00 for DRG 410, chemotherapy; to R2=.38 for DRG 320, kidney and urinary tract infections, age > 17 years with complications or comorbidities). The APACHE-L score, which is objective and readily available in our nation's hospitals, shows considerable promise as a severity of illness adjuster for a subset of DRGs.
影响因子：
--
作者：
D. Wagner;E. Draper
通讯作者：
D. Wagner;E. Draper
疾病严重程度测量的统计验证。
影响因子：
12.7
作者：
Wagner,DP;Knaus,WA;Draper,EA
通讯作者：
Draper,EA