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A Case-Mix Measurement

Joseph S. Gonnella, MD; Mark C. Hornbrook, PhD; Daniel Z. Louis, MS

JAMA. 1984;251(5):637-644.

Abstract
Measurement of illness severity is required to evaluate diagnostic efficiency of physicians, assess quality of care, understand utilization of health services, design clinical trials, and reimburse hospitals on the basis of output. "Staging" is a method for measuring severity of specific, well-defined diseases. Staging defines discrete points in the course of individual diseases that are clinically detectable, reflect severity in terms of risk of death or residual impairment, and possess clinical significance for prognosis and choice of therapeutic modality. Medical staging criteria have been developed for 420 diagnoses and converted into "coded" criteria for the major diagnostic coding systems. Coded criteria can be efficiently applied to computerized hospital discharge abstracts to derive a comprehensive case-mix classification system. Uses of staging in epidemiologic, case-mix, and utilization analyses are illustrated for diabetes mellitus.

(JAMA 1984;251:637-644)

Author Affiliations
From the Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia (Dr Gonnella); the Division of Intramural Research, National Center for Health Services Research, Department of Health and Human Services, Rockville, Md (Dr Hornbrook); and Syste-Metrics, Inc, Santa Barbara, Calif (Mr Louis). Dr Hornbrook is now with the Health Services Research Center, Kaiser-Permanente Medical Care Program, Portland, Ore.

Footnotes
The views expressed in this article are those of the authors, and no official endorsement by the National Center for Health Services Research is intended or should be inferred.

Reprint requests to Center for Research in Medical Education and Health Care, Jefferson Medical College, 1025 Walnut St, Philadelphia, PA 19107 (Dr Gonnella).

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