Advertisement

European Journal of Epidemiology

, Volume 10, Issue 5, pp 625–632 | Cite as

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

  • Miguel A. Asenjo
  • Lluisa Baré
  • José M. Bayas
  • Andreu Prat
  • Rafel Lledó
  • Joan Grau
  • Lluis Salleras
Article

Abstract

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.

Key words

Hospitalized patients Severity of illness index 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ahicart C. Técnicas de medición del case-mix hospitalario, I: Los procesos productivos en el hospital y la medición del producto hospitalario. Hospital 2000 1987; 2: 4–22.Google Scholar
  2. 2.
    Hornbrook M. Hospital case-mix: its definition, measurement and use: part I. The conceptual framework. Medical Care Rev 1982; 99: 1–43.Google Scholar
  3. 3.
    Hornbrook M. Hospital case-mix: its definition, measurement and use: part II. Review of alternative measures. Medical Care Rev 1982; 39: 73–123.Google Scholar
  4. 4.
    Ahicart C. Técnicas de medición del case-mix hospitalario III. As-score, patient severity of illness, Apache, staging disease, patient managing categories. Hospital 2000 1988; 3 (suppl): 3–22.Google Scholar
  5. 5.
    Jencks SF, Dobson A, Willis P, Hirsch PF. Evaluating and improving the measurement of hospital case-mix. Health Care Fina Rev (annual supplement) 1984: 1–11.Google Scholar
  6. 6.
    Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD. Case-mix definitions by diagnosis-related groups. Med Care 1980; 18 (suppl): 1–53.Google Scholar
  7. 7.
    Berman RA, Green J, Kwo D, Safian KF, Botnick L. Severity of illness and the teaching hospital. J Med Educ 1986; 61: 1–9.Google Scholar
  8. 8.
    Goldfarb MG, Coffey RM. Case-mix differences between teaching and nonteaching hospitals. Inquiry 1987; 24: 68–84.Google Scholar
  9. 9.
    Gross PA. Severity of illness and other confounders of quality measurement. In: Wenzel RP, ed. Assessing quality health care: perspectives for clinicians. Baltimore: Williams and Wilkins, 1992: 101–125.Google Scholar
  10. 10.
    Horn SD. Measuring severity of illness: comparison across institutions. Am J Public Health 1983; 73: 25–31.Google Scholar
  11. 11.
    Horn SD, Bulkley G, Sharkey PD, Chambers AF, Horn RA, Schramm CJ. Interhospital differences in severity of illness: Problems for prospective payment based on diagnosis-related groups (DRGs). N Engl J Med 1985; 313: 20–24.Google Scholar
  12. 12.
    Maxwell RJ. Cost of teaching hospitals. Br Med J 1984; 289: 714–715.Google Scholar
  13. 13.
    Horn SA, Horn RA, Sharkey PD, Chambers AF. Severity of illness within DRGs. Homogeneity study. Med Care 1986; 24: 225–235.Google Scholar
  14. 14.
    Horn SD, Sharkey PD. Measuring severity of illness to predict patient resource use within DRGs. Inquiry 1983; 20: 314–321.Google Scholar
  15. 15.
    Horn SA, Sharkey PD, Chambers AF, Horn RA. Severity of illness within DRGs: Impact on prospective payment. Am J Public Health 1985; 75: 1195–1199.Google Scholar
  16. 16.
    Horn SD, Horn RA. Reliability and validity of the severity of illness index. Med Care 1986; 24: 159–78.Google Scholar
  17. 17.
    Horn SD, Sharkey PD, Bertram DA. Measuring severity of illness: Homogeneous case-mix groups. Med Care 1983; 21: 14.Google Scholar
  18. 18.
    Horn DS, Chachich B, Clopton C. Measuring severity of illness: a reliability study. Med Care 1983; 21: 705–714.Google Scholar
  19. 19.
    Richards T, Lurie N, Rogers WH, Brook RH. Executive summary. Med Care 1988; 26 (suppl): 1–29.Google Scholar
  20. 20.
    Schumacher DN, Parker B, Kofie V, Munns JM. Severity of illness index. A reliability study and policy implications. Med Care 1987; 25: 695–704.Google Scholar
  21. 21.
    Thomas JW, Ashcraft ML. Measuring severity of illness: a comparison of interrater reliability among severity methodologies. Inquiry 1989; 26: 483–492.Google Scholar
  22. 22.
    Cochran WG. Sampling techniques, 3rd ed. New York: John Wiley & Sons, 1977: 24–25.Google Scholar
  23. 23.
    Iezzoni LI, Shwartz M, Moskowitz MA, Ash AS, Sawitz E, Burnside S. Illness severity and costs of admissions at teaching and nonteaching hospitals. JAMA 1990; 264: 1426–1431.Google Scholar
  24. 24.
    SPSS, Inc. SPSS/PC+ Advanced Statistics™ 4.0. Chicago: SPSS Inc., 1990.Google Scholar
  25. 25.
    Horn SD, Sharkey PD, Buckle JM, Backofen JE, Averill RF, Horn RA. The relationship between severity of illness and hospital length of stay and mortality. Med Care 1991; 29: 305–317.Google Scholar
  26. 26.
    Horn SD, Horn RA, Hamilton M. Profiles of physician practice and patient severity of illness. Am J Public Health 1986; 76: 532–535.Google Scholar
  27. 27.
    Frick AP, Grisez Martin S, Shwartz M. Case-mix and cost differences between teaching and nonteaching hospitals. Med Care 1985; 23: 283–295.Google Scholar

Copyright information

© Kluwer Academic Publishers 1994

Authors and Affiliations

  • Miguel A. Asenjo
    • 1
  • Lluisa Baré
    • 2
  • José M. Bayas
    • 2
  • Andreu Prat
    • 2
  • Rafel Lledó
    • 1
  • Joan Grau
    • 3
  • Lluis Salleras
    • 2
  1. 1.Department of Technical Management, Hospital Clinic i Provincial de Barcelona, and Department of Public Health and Health Care Legislation, University of BarcelonaBarcelonaSpain
  2. 2.Service of Preventive Medicine, Hospital Clínic i Provincial de Barcelona, and Department of Public Health and Health Care LegislationBarcelonaSpain
  3. 3.Department of Hospital Finance and Management, Hospital Clínic i Provincial de Barcelona, and Department of Public Health and Health Care LegislationBarcelonaSpain

Personalised recommendations