Iezzoni L I, Moskowitz M A
Evans Memorial Department of Clinical Research and Medicine, Boston University Medical Center, MA.
JAMA. 1988 Dec 2;260(21):3159-63. doi: 10.1001/jama.260.21.3159.
Interest has focused recently on measuring severity of illness, both to improve the fairness of diagnosis related group-based reimbursement and to facilitate judgments about hospital quality of care. MedisGroups is a prominent, proprietary severity-measurement system, recently mandated for use by all Pennsylvania hospitals. We reviewed MedisGroups and its key clinical findings. MedisGroups produces admission scores, from 0 through 4, indicating increasing risk of imminent organ failure. Score computation is independent of diagnosis, but many key clinical findings are disease specific and require particular diagnostic technologies. Using a database including patients 65 years of age and older from 24 hospitals, we found that fewer than 1% of patients with scores of 0 or 1 died in-hospital, compared with 60% of those with scores of 4. Questions remain about the impact of the procedural nature of many key clinical findings and the independence from diagnosis. Further study is needed to determine the utility of MedisGroups for policy purposes.
最近，人们的关注点集中在衡量疾病的严重程度上，这既是为了提高基于诊断相关分组的报销的公平性，也是为了便于对医院的医疗质量做出判断。MedisGroups是一个著名的专有严重程度测量系统，最近宾夕法尼亚州所有医院都被要求使用。我们审查了MedisGroups及其关键临床发现。MedisGroups生成的入院分数从0到4，表明即将发生器官衰竭的风险增加。分数计算与诊断无关，但许多关键临床发现是特定疾病的，需要特定的诊断技术。通过使用一个包含来自24家医院的65岁及以上患者的数据库，我们发现，分数为0或1的患者中，不到1%在医院死亡，而分数为4的患者中这一比例为60%。关于许多关键临床发现的程序性本质以及与诊断的独立性的影响，仍存在疑问。需要进一步研究以确定MedisGroups在政策方面的效用。
