Balicer Ran D, Shadmi Efrat, Geffen Keren, Cohen Arnon D, Abrams Chad, Siemens Karen Kinder, Regev-Rosenberg Sigal
Planning & Health Policy Division, Clalit Health Services Head Offices, Israel.
Harefuah. 2010 Oct;149(10):665-9, 683, 682.
Equitable distribution of healthcare resources and fair assessments of providers' performance necessitates adjusting for case-mix. The feasibility and validity of applying case-mix measures, based on inpatient and outpatient diagnoses, has yet to be tested in Israel.
Assessment of the feasibility and validity of applying the Johns-Hopkins University Adjusted Clinical Groups (JHU-ACG) case-mix system, using diagnoses from hospitalizations or physician visits, at Clalit Health Services (CHS).
A representative sample of 117,355 enrollees during 2006. The distribution of ACG morbidity groups and relative resource weights in CHS and the degree to which it corresponds to ACGs' distribution in other countries was examined. The degree to which ACGs can explain utilization of primary and specialty care in CHS was determined.
ACGs explained a large percent of the variance in primary care and specialist visits (R2 = 38-54%), better than age and gender alone (R2 =12-13%). A high degree of correlation was found between the distribution of the population into ACG groups in CHS and samples from Canada or the United States (r = 0.91), and between the relative resource use for each ACG at CHS compared to the Canadian and US samples (r = 0.78-0.98).
The JHU-ACG case-mix system can be applied in the Largest healthcare organization in Israel based on diagnoses generated at hospitalizations and physician visits. The system can now be applied for a variety of purposes, including resource allocation according to medical need, and for conducting fair assessments of providers' performance, which are currently being tested by CHS.
医疗资源的公平分配以及对医疗服务提供者绩效的公正评估需要根据病例组合进行调整。基于住院和门诊诊断应用病例组合措施的可行性和有效性在以色列尚未得到检验。
评估在克拉利特医疗服务机构（Clalit Health Services，CHS）应用约翰·霍普金斯大学调整临床分组（Johns-Hopkins University Adjusted Clinical Groups，JHU-ACG）病例组合系统的可行性和有效性，该系统使用住院治疗或医生诊疗的诊断信息。
选取2006年期间117355名参保人的代表性样本。研究了CHS中ACG发病分组和相对资源权重的分布情况，以及其与其他国家ACG分布的对应程度。确定了ACG能够解释CHS中初级和专科护理利用情况的程度。
ACG解释了初级护理和专科诊疗差异的很大一部分（R2 = 38 - 54%），比仅考虑年龄和性别时（R2 = 12 - 13%）效果更好。CHS中人群在ACG组中的分布与加拿大或美国样本之间存在高度相关性（r = 0.91），CHS中每个ACG的相对资源使用与加拿大和美国样本之间也存在高度相关性（r = 0.78 - 0.98）。
基于住院治疗和医生诊疗产生的诊断信息，JHU-ACG病例组合系统可应用于以色列最大的医疗组织。该系统现在可用于多种目的，包括根据医疗需求进行资源分配，以及对医疗服务提供者的绩效进行公正评估，目前CHS正在对此进行测试。
