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Biomedical subjects

D P Macioce

Publications and source records attributed to D P Macioce.

5 recordsLinked to original sources
PubMed1993

An Ambulatory Service Weighting System: making sense out of millions of ambulatory claims.

This paper describes a cost-based relative value scale to use in measuring the intensity and costs of hospital services, regardless of the place of service--inpatient or outpatient. The Pittsburgh Research Institute's AMBULATORY SERVICE WEIGHTING SYSTEM (ASWS) is a service-driven relative value scale. The major components of the system are: 1) a classification of services and procedures provided in ambulatory settings; 2) a cost-based relative intensity weight for each service; and 3) a computerized system that assigns a relative weight to each ambulatory patient based on the specific services recorded on the patient bill and rendered during a particular visit or in multiple encounters. Computerized decision rules are also incorporated as edits to adjust for inconsistent revenue or procedure coding practices. The system basically standardizes the millions of outpatient claims received by third party payors so that intensity can be measured consistently across providers, and payment systems can be modified accordingly. The ASWS identifies service intensity on the same relative value scale as inpatient care, and thus, it can serve as a site-neutral classification of health care services for prospective payment and utilization management as well as a measure of resource intensity.

Ambulatory Care↗
PubMed1991

PMCs--an alternative to DRGs for trauma care reimbursement.

Payments made for inpatient trauma care were compared using two different patient classification systems--Patient Management Categories (PMCs) and Diagnosis Related Groups (DRGs). Two databases were used in this study: 1) estimated costs for all inpatient claims from one large payor for adult injured patients (n = 5,256) treated at 79 acute care facilities (trauma centers and non-trauma centers) in one geographic region; and 2) hospital charges from statewide, all-payor Maryland data, including 25,987 adult injured patients. The accuracy of PMCs and DRGs in predicting actual costs was examined by level of injury severity and by types of hospital, trauma center vs. non-trauma center. Level of injury (minor, single significant, multiple significant, and major) were defined and operationalized using PMCs. Overall, both DRG and PMC payment systems were nearly equal to the actual costs associated with all injured patients. This relationship can be designed into the weighting scale used for payment. The distribution of DRG payments by injury severity level, however, is not reflective of the differential resources required to manage each patient type. In particular, multiple injuries and major injuries that require the specialized services of a trauma center were inaccurately categorized by DRGs and systematically underpaid by 21.0% to 39.0% by DRG payment. By contrast, the Patient Management Category System classifies patients into more clinically specific and accurate categories and offers a more equitable method of distributing payments by injury severity. These same relationships were also found at the hospital level, demonstrating the potential for use of PMCs as an equitable and viable alternative.

Costs and Cost Analysis↗
PubMed1990

Identifying injuries and trauma severity in large databases.

In order to assess the cost and effectiveness of inpatient trauma care, trauma patients and their levels of severity must first be identified accurately using data from all hospitals, not just trauma centers. The present study provides the methodology to identify injuries and trauma severity using discharge abstract data collected routinely by all hospitals. In this study, the validity of defining trauma patients using routinely collected abstract data and two computerized patient classifications--Diagnosis Related Groups (DRGs) and Patient Management Categories (PMCs)--was tested using the trauma registry data of one major trauma center as the gold standard. Medical records were reviewed to assess whether patients were accurately classified as having injuries by each of the two systems and whether patients were incorrectly omitted from the registry. Results indicated that trauma patients are more accurately identified by PMCs (95.1% accuracy) than by either DRGs (44.4% accuracy) or the registry standard itself (91.8% accuracy). Because patients identified by DRGs as trauma were not likely to be injured (21.2% specificity), and many true injuries were not identified as such by DRGs (47.9% sensitivity), per case payments to hospitals are unpredictable, and management based on DRG data is misleading. By contrast, PMCs (97.8% sensitivity; 77.7% specificity) can be used to improve injury surveillance methods, to monitor outcomes in terms of morbidity and mortality, and to make hospital payment systems more equitable.

Databases, Bibliographic↗
PubMed1990

Do trauma centers improve outcome over non-trauma centers: the evaluation of regional trauma care using discharge abstract data and patient management categories.

Development of regional medical care systems to treat patients who sustain major accidental injuries (trauma victims) has been based on autopsy studies which demonstrate that hospitals that meet certain accepted criteria of readiness (trauma centers) can prevent needless deaths of trauma victims. However, since only autopsy data have been available from non-trauma centers, it has not previously been possible to compare morbidity data between trauma centers and non-trauma hospitals. This study examines discharge abstract data and a new patient classification system called patient management categories (PMC) which are generated from this abstract data to evaluate length of stay (LOS), complications, and death to compare morbidity and mortality data from trauma centers and non-trauma centers. Discharge abstracts for 1,332 patients with the PMC of femoral shaft fracture with operation were obtained from all hospitals in Western Pennsylvania and Maryland for 1 year. Data from trauma centers were identified and compared to non-trauma centers using the following criteria: time to OR (less than or equal to 2 days vs. greater than 2 days), age (0-12, 13-55, greater than 55 years), associated injuries, and development of complications and death. Patients treated in trauma centers had significantly fewer complications (21% vs. 33%; p less than 0.001) and lower mortality rates (p less than 0.05) than those treated in non-trauma centers. Associated injuries, age, complications, and/or delay in time to OR significantly increased intensity and length of stay in both trauma and non-trauma centers. This significantly increased the cost of care provided to these patients in both types of centers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗