ABSTRACT
Measuring severity of illness within diagnosis-related groups (DRGs) has become increasingly important because of the growing need to compare outcomes across providers. In response to these needs, the Health Care Financing Administration (HCFA) has developed a DRG-based severity system as a refinement to its current Medicare DRG structure. As a result of this recent HCFA research, all-payer severity-adjusted DRGs (APS-DRGs) have been developed to provide a uniform approach for severity classification that is also applicable to the all-payer population.
Subject(s)
Diagnosis-Related Groups/classification , Severity of Illness Index , Centers for Medicare and Medicaid Services, U.S. , Diagnosis-Related Groups/economics , Health Services Research , Humans , Medicare , Models, Theoretical , New York , Patient Discharge , Pilot Projects , Prospective Payment System , United StatesABSTRACT
Despite growing acceptance of the fact that women with early-stage breast cancer have similar outcomes with lumpectomy plus radiation as with mastectomy, many studies have revealed the uneven adoption of such breast-conserving surgery. Discharge data from the Hospital Cost and Utilization Project, representing multiple payers, locations, and hospital types, demonstrate increasing trends in breast-conserving surgery as a proportion of breast cancer surgeries from 1981 to 1987. Women with axillary node involvement were less likely to have a lumpectomy, even though consensus recommendations do not preclude this form of treatment when local metastases are present. Non-White race, urban hospital location, and hospital teaching were associated with an increased likelihood of having breast-conserving surgery.
