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In-Depth Information
Chapter 7
Risk Adjustment Based
Upon Resource Utilization
IntroductIon
Resource utilization is based upon the assumption that patients with more severe problems will utilize
more resources, and the most severe patients will require the most resources. This type of index assumes
that no unnecessary resources are utilized and that treatments, medications, and laboratory diagnostics
are required because of the severity of the patient condition. However, if the provider is extravagant
in the use of resources, the patient will look severe. Then, too, some of the resources used will depend
upon the admitting condition.
Suppose, for example, that a patient complains of chest pain. This could be a cold, asthma, acid reflux,
or a heart attack. Without expending some resources for diagnostics, it would be impossible to find the
actual patient condition. Again, a patient's level of severity is defined using outcomes. Therefore, there
will be some problem with validation. We can examine the issue of validation by comparing the index
discussed here to the Charlson Index and the APRDRG.
There are three different resource demand indices provided with the National Inpatient Sample: for
mortality, for length of stay, and for disease staging. We will examine all three to see how they are simi-
lar, and how they are different. This index is also proprietary and was developed by Thomson Medstat.
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