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Multiple Diagnoses (multiple + diagnosis)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

HEALTH SERVICES RESEARCH, Issue 4p1 2004
Colin Preyra
Objective. To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. [source]

Patients Spend More Time With the Physician for Excision of a Malignant Skin Lesion Than for Excision of a Benign Skin Lesion

DERMATOLOGIC SURGERY, Issue 3 2004
Steven R. Feldman MD
Background. Currently, there is a difference in reimbursement between excision of malignant and benign lesions. There is concern that there is not sufficient rationale for differential reimbursement for these two procedures. Objective. To assess whether there is a difference in physician work involved with excision of benign versus malignant skin tumors. Method. We searched National Ambulatory Medical Care Survey data for visits at which excision of benign and malignant skin lesions was performed. We compared the time spent with the physician at these two types of visits. To exclude confounding issues unrelated to the excision that would affect the time of visit, we excluded visits at which multiple diagnoses were addressed. Results. The mean time spent with the physician at visits for excision of benign lesions was 22.9±1.0 minutes. The mean time spent with the physician at visits for excision of malignant lesions was 30.0±1.7, 30% longer (p < 0.001). The longer time for excision of malignant lesions remained significant after controlling for age, gender, and race. Conclusion. Excision of malignant lesions involves more physician work than does excision of benign lesions. Elimination of differential compensation for benign versus malignant skin lesion procedures would not enhance the accuracy of reimbursement. In the absence of any compelling rationale to change the existing differential reimbursement, the proposals to do so are not warranted. [source]

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

HEALTH SERVICES RESEARCH, Issue 4p1 2004
Colin Preyra
Objective. To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. [source]

Chronic disease profiles in remote Aboriginal settings and implications for health services planning

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2010
Wendy E. Hoy
Abstract Objective: To report the short-term experiences and outcomes of a program to support chronic disease management in three remote communities in Top End Northern Territory and in two Aboriginal Medical Services (AMSs) in Western Australia, and to discuss the implications of findings for health service delivery and policy. Methods: Programs were health-worker centred. They espoused regular screening of all adults for chronic disease, initiation and modification of treatment where indicated and rigorous documentation. Process measures were documented and rates of hypertension, renal disease and diabetes among adults were calculated. Results: Rates of hypertension, proteinuria and diabetes rose throughout adult life and multiple diagnoses were common. Most people with these conditions were young or middle age adults. Rates were uniformly excessive relative to AusDiab data, but varied greatly among settings. Adherence to protocols improved, many new diagnoses were made, treatments were started or modified and blood pressures in treated hypertensive people fell. In the NT, productivity was seriously limited by lack of health workers and their absenteeism. In the WA AMSs, executive and staff support carried the programs forward to a sustainable future, despite various challenges. Conclusions: Integrated chronic disease testing must be repeated throughout adult life for timely diagnosis. Health workers can perform all tasks well, with appropriate supports. Blood pressure outcomes alone predict lower cardiovascular and renal mortality. The findings support incorporation of chronic disease into lifetime health care plans. [source]