Physiological Computing Systems by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030279509
Publisher: Springer International Publishing

3 Patient Classification Systems

Developed countries use PCSs for clinical purposes and also as a basic tool for cost management. PCSs are based on the idea that diagnoses, procedures and drugs are good at predicting health spending, so it is possible to obtain clinical information and expenditure with the same data set. PCSs are built from a set of clinical rules that assign each patient to one of a limited collection of homogeneous groups in terms of resources use and/or health status. There are different families of PCS, those based on diagnosis/procedure and severity called Diagnosis Related Groups (DRGs), those based on clinical risk called Adjusted Clinical Groups (ACGs) and, in a residual way, those based on disability (DPs).

The family based on DRGs is the most used all over the world [25] to analyze the hospital case mix, as well as for reimbursement and financing healthcare processes. DRGs were created in Yale University at the end of 60’s as a system to classify each healthcare episode at a hospital, creating groups with clinical coherence and similar use of hospital resources [2]. The final goal was to obtain a capitation payment system for MEDICAID, a state program in the U.S. that help covering medical costs to people with limited income or resources. In PCSs, every episode of the same patient can create a different DRG, being the same or different depending on the diagnoses assigned. So we will find a DRG for each inpatient. Associated to each DRG there is a weight reflecting the consumption of resources respect to an average DRG, which is considered as a comparison unit. Some countries use this weight, along with other metrics (hospital stay, and others), to compare hospital activity and funding them.

The main limitation of DRGs is that they only consider inpatients, but in the healthcare system there is much more activity (primary care, outpatients, pharmacy). Additionally, DRGs just analyze information for healthcare episodes, without considering data during a period of time. The identification of chronic conditions based on DRGs can be a difficult task since these diseases tend to be reflected in certain diagnosis and pharmacy dispensation. Therefore, for chronic patients identification, it would be more appropriate to use a system considering all encounters of the patient with the health system. PCSs that are prepared to take into account all encounters of the patient with the health system are named Population Classification Systems or Population Groupers. As previously indicated in Sect. 1, Population Groupers usually consider age, gender, diagnoses and procedures and other factors that affect the health status during a certain period of time [10]. Over the last years, pharmacy dispensation has also been incorporated to the clinical rules of some Population Groupers, transforming the drug into a diagnosis code when there is a direct relationship between them, in order to obtain a more complete knowledge about the health status.

Population Groupers named CRGs (developed by 3MTM) are a population classification system using inpatient and ambulatory diagnosis and procedure codes, pharmaceutical data and functional

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