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At least 19 recordsLinked to original sources
PubMed1995

Functional bowel disorders. A multicenter comparison of health status and development of illness severity index.

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0-100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months x 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.

Abdominal Pain↗
PubMed1992

Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index.

Severity-of-illness scales have proven valuable in assessing clinical outcomes and resource consumption in adult and pediatric intensive care, but they have been less extensively developed for neonatal care. The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS). From the 76 original TISS items, 42 were deleted and 28 added to form the NTISS. Like TISS, NTISS assigns score points from 1 to 4 for various intensive care therapies. Admission-day NTISS scores were calculated for 1643 newborns admitted to three neonatal intensive care units (NICUs) between November 1, 1989, and September 30, 1990. NTISS scores ranged from 0 to 47 with a mean of 12.3 +/- 8.7 (SD). There was little correlation with birth weight (r = -.11) or gestational age (r = -.17), but NTISS scores were highly correlated with expected markers of illness severity, including mortality risk estimates by neonatal attending physicians (r = .70, P < .0001), in-hospital mortality rates (P < .05), and a measure of nursing acuity (Medicus) (r = .69, P < .0001). In addition, admission-day NTISS scores were found to be predictive of both NICU length of stay (r = .37, P < .0001) and total hospital charges for survivors (r = .65, P < .0001). It is concluded that NTISS is a valid measure of therapeutic intensity that is independent of birth weight and can be used as an indicator of neonatal illness severity and resource utilization. Further validation in other NICUs is required.

Hospitalization↗
PubMed1984

The Severity of Illness Index as a severity adjustment to diagnosis-related groups.

This article discusses the Severity of Illness case-mix groups, and suggests a refinement to diagnosis-related groups (DRG's) designed to accommodate the important element of patient severity. An application of the suggested refinement is presented in a discussion of the efficient production of hospital services. The following areas are addressed. A brief summary of the goals and development of the Severity of Illness Index, and the methodology used to collect severity of illness data on hospital inpatients. Comparative analyses of the resulting case-mix groups within hospitals, and an application of severity-adjusted diagnosis-related groups case-mix definitions. The contribution of the variation in physician practice patterns to the variation in resource use per patient within a hospital. Cross-hospital comparisons. Some of the consequences of incorporating a patient severity refinement into the prospective payment system.

Costs and Cost Analysis↗
PubMed1980

"AS-SCORE": a multi-attribute clinical index of illness severity.

As techniques to assess the quality of care have proliferated, appropriate concern has arisen about study methods employed by researchers. In particular, studies that focus on a single variable, such as mortality, length of stay (LOS), or complication rate, have sometimes been justly criticized because they have failed to account for differences in the case mixes of providers and the differing severity of illnesses among patients treated. The issue has become even more controversial as third-party payers have attempted to tie reimbursement mechanisms to a single variable, often median or average LOS or average charges for given diagnoses. In the February 1980 issue of the Quality Review Bulletin, the authors of this article discussed a method to investigate variations from areawide average LOS (see "Length of Stay Variations: A Focused Review," pagae 6). The authors concluded that actual differences exist among plhysician practice patterns for the treatment of the same conditions. Although not discussed in that article, the authors devised a method of analysis that incorporated case mix and severity of illness variables to determine whether the correlations they reported were valid. In this article, the authors explain the theory and application of the illness severity index they devised. The index may be of special interest to researchers concerned about whether they are comparing "apples with oranges" or truly discovering differences among providers' practice patterns.--The Editors.

Adult↗
PubMed1987

Severity of Illness Index and the Adverse Patient Occurrence Index. A reliability study and policy implications.

Seven hundred fifty-two randomly selected charts from seven teaching hospitals were rated by pairs of medical record analysts. The Severity of Illness Index was unreliable with an interrater-agreement rate of 73% (kappa statistic = 0.41), and demonstrated a significant (P less than 0.0001) association with the Adverse Patient Occurrence (APO) Index. This suggests that the Severity of Illness Index is not differentiating severity of illness from quality of care. The fair to poor field reliability stems from underlying instrument subjectivity, lack of clear referent groups, and time pressure. The APO Index was also found to be unreliable (r = 0.33 and range = -0.05-0.58). Greater attention should be directed to improving objective discharge abstract, billing, and laboratory data for measuring patient severity and adverse patient occurrences.

Abstracting and Indexing↗
PubMedDate not supplied

[Construction and validation of a severity of illness index of patients hospitalized in clinical areas].

Severity of illness indexes for hospitalized patients are frequently used for the assessment of hospital performance. The purpose here was to develop and validate a quantitative index for clinical areas which could measure severity of illness during hospitalization period and would be easy to obtain from the information contained in a regular clinical chart. The construction included item selection and search for items weights. Experts and literature were consulted and 74 clinical records provided empirical information. The result was the proposal of an index with two alternatives: one quantitative and the other ordinal with four levels of severity. Validation included four aspects of validity, general reliability, interrater agreement and internal consistency. Sixteen specialized physicians assessed content and face validity. One hundred clinical records of discharged patients were used to assess criterion, construct validity and reliability. Results show satisfactory validity in almost all aspects. The reliability coefficient was 0.95, Kappa coefficient was 0.4 for the ordinal index and correlation coefficients over 0.93 for the quantitative one. The index is ready for current applications in this context although some suggestions for future improvements were also included.

Adolescent↗
PubMed1994

Relationship between severity, costs and claims of hospitalized patients using the Severity of Illness Index.

The results of the prospective application of Horn's 'Severity of Illness Index' in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole.

Adolescent↗
PubMed1986

Reliability and validity of the Severity of Illness Index.

The authors discuss the objectives and definition of the Severity of Illness Index, which has been developed and refined at The Johns Hopkins University over the past 5 years. In addition, the training program for raters, the method used to ascertain reliability, and data from reliability testing in 18 hospitals are described. After at least 2 months' experience with severity scoring, the average agreement between hospital raters and the staff reliability rater varied between 90.8% and 97.7%, with an overall weighted average agreement of 93.5%. Several methods to evaluate the validity of the Index are presented. The conclusion is that the Severity of Illness Index is a reliable and valid tool for measuring inpatient severity of illness.

Abstracting and Indexing↗
PubMed1981

Validity, reliability and implications of an index of inpatient severity of illness.

We discuss statistical characteristics of AS-SCORE, a recently developed index of illness severity for medical patients. The acronym "AS-SCORE" indicates the five major attributes of the index: age, system involved, stage of the disease, complications and response to therapy. The reliability of both the four-class system (k = .84) and the additive point scoring system (r = .92) was substantiated by two judges who independently classified and scored 105 records. We also tested the content validity of the four-class system and found that as severity increased there was a concomitant increase in hospital charges, laboratory charges, length of stay, number of consultations and mortality rates. In addition, we performed a regression analysis to determine the relative contributions of each of the attributes to the AS-SCORE value. We describe how we used the AS-SCORE severity of illness index to compare physician practice patterns and we suggest several other potential uses. We concluded that the AS-SCORE index is a reliable, valid and useful prototype method to assess differences in severity of illness for medical patients.

Abstracting and Indexing↗
PubMed1993

Birth weight and illness severity: independent predictors of neonatal mortality.

BACKGROUND: Low birth weight is a major determinant of neonatal mortality. Yet birth weight, even in conjunction with other demographic markers, is inadequate to explain the large variations in neonatal mortality between intensive care units. This variation probably reflects differences in admission severity. The authors have recently developed the Score for Neonatal Acute Physiology (SNAP), an illness severity index specific for neonatal intensive care, and demonstrated illness severity to be a major determinant of neonatal mortality. OBJECTIVE: To define the relative contributions of birth weight and illness severity to the risk of neonatal mortality and to identify other significant independent risk factors. METHODS: Logistic regression was used to analyze data from a cohort of 1621 consecutive admissions to three neonatal intensive care units (92 deaths), to test six alternative predictive models. The best logistic model was then used to develop a simple additive clinical score, the SNAP Perinatal Extension (SNAP-PE). RESULTS: These analyses demonstrated that birth weight and illness severity are powerful independent predictors across a broad range of birth weights and that their effects are additive. Below 750 g, there is an interaction between birth weight and SNAP. Other factors that showed independent predictive power were low Apgar score at 5 minutes and small size for gestational age. Separate derivation and test samples were used to demonstrate that the SNAP-PE is comparable to the best logistic model and has a sensitivity and specificity superior to either birth weight or SNAP alone (receiver-operator characteristic area .92 +/- .02) as well as excellent goodness of fit. CONCLUSION: This simplified clinical score provides accurate mortality risk estimates for application in a broad array of clinical and research settings.

Birth Weight↗
PubMed2004

The relationship between illness severity, sociodemographic factors, general self-concept, and illness-specific attitude in Swedish adolescents with epilepsy.

PURPOSE: The aim of this study was to describe the relationship between the epilepsy condition (illness severity), sociodemographic factors, general self-concept, and illness-specific attitude in adolescents with uncomplicated epilepsy. METHODS: Adolescents, aged 13-22, fulfilling criteria registered in four Swedish hospitals, answered questionnaires (n = 149). The instruments "I think I am" and "Sense of coherence" measured the patients' general self-concept. The "Child Attitude Toward Illness Scale" measured illness-specific attitude. A summary score (index) calculated from seizure frequency, seizure type, and antiepileptic drug (AED) with side effects measured "Illness Severity". RESULTS: Illness severity was significantly related to the participants' general self-concept, as well as to their attitude toward their condition; i.e. higher illness severity scores were correlated with lower sense of coherence (SOC), poorer self-esteem, and a more negative attitude towards the epilepsy condition. Females had more severe illness according to the Illness Severity Index, with almost 80% found in the moderate and high severity groups as compared to 63% of males in the moderate/high severity groups. CONCLUSIONS: It was concluded that the severity of the epilepsy condition was related to the adolescents' general self-concept and illness-specific attitude, but further research is needed to understand the causality of the relationship. The brief assessment of illness severity, constructed and used in this study should be addressed and developed further.

Adolescent↗
PubMed1985

The severity of illness index: an interview with Susan D. Horn.

HCSM's interview this month is with Susan D. Horn, PhD, Associate Director, Center for Hospital Finance and Management at Johns Hopkins University in Baltimore, Maryland. Dr. Horn, heading a research team at Johns Hopkins, has developed a patient classification system based on patient severity and medical diagnosis. In early testing, this index has proven more accurate than DRGs in capturing the homogeneity of resource use in individual diagnostic categories. Severity data also has implications for health care strategic planning. In this interview, Dr. Horn discusses the index and its benefits and then contrasts it to the DRG system.

Costs and Cost Analysis↗
PubMed2006

Validation of the Cumulative Illness Rating Scale (CIRS) in hospitalized nonagenarians.

This is a retrospective analysis of patients aged 90-99 years, admitted over a 6-month period to a district hospital. One hundred three patients were included in the study with an average age of 92 years and a male to female ratio of 1:3. Fifty-five percent of the patients hospitalized came from nursing care facilities. Comparisons were made of patient characteristics from nursing homes and the community. The physical burden of illness was measured by the CIRS, Illness Severity Index (SI), and Co-morbidity Index (CI). The average length of stay was 6.3 days for those from nursing care facilities and 10.2 days from the community as compared with 3.3 days for total hospital in-patients. Excluding deceased patients there was a significant (p < 0.05) correlation between patient's CIRS to length of stay in hospital but was equivocal for SI and CI. There were no association between patient's CIRS, SI, and CI to mode of referral and residence. The mortality rate for this group was 13% as compared with the hospital rate of 10.2%. CIRS, SI, and CI were useful in distinguishing the mortally ill from the morbidly ill; otherwise there were no differences, between patients who hail from nursing care facilities or from the community and whether they were referred by carers, nursing staff, medical practitioners/specialists or themselves. There were significant differences in the CIRS scores between deceased and survivors indicating CIRS is potentially useful tool in predicting outcome. The SI and CI composites performed equally well in predicting outcome.

Aged, 80 and over↗