Skip Navigation Archive: U.S. Department of Health and Human Services U.S. Department of Health and Human Services
Archive: Agency for Healthcare Research Quality www.ahrq.gov
Archival print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Mortality Measurement: Development of the 3M™ All Patient Refined Diag

Presentations from a November 2008 meeting to discuss issues related to mortality measures.

Figure 2-1. Three-phase process for determining patient severity of illness subclass (Text Description)

Flowchart of the three-phase process of determining the severity of illness subclass. The process begins with the step to Assign APR DRG (All Patient Refined Diagnosis Related Group).

Phase 1 is "Determine the severity level of each secondary diagnosis," and includes the following steps:

  • Eliminate secondary diagnoses that are associated with the principal diagnosis.
  • Assign each secondary diagnosis its standard severity of illness level.
  • Modify the standard severity of illness level of each secondary diagnosis based on:
    • Age
    • APR DRG and PDX
    • APR DRG

Phase 2 is "Determine the base severity of illness subclass of the patient," and includes the following steps:

  • Eliminate secondary diagnoses that are associated with other secondary diagnoses.
  • Set the base severity of illness subclass of the patient to the highest severity of illness level of any of the secondary diagnoses.
  • Reduce the subclass of patients with a base subclass of major or extreme to the next lower subclass unless the patient has multiple high severity of illness secondary diagnoses.

Phase 3 is "Determine the final severity of illness subclass of the patient," and includes the following steps:

  • Modify patient severity of illness subclass based on the presence of specific combinations of:
    • APR DRG and principal diagnosis.
    • APR DRG and age, or APR DRG and principal diagnosis and age.
    • APR DRG and non-OR [operating room] procedure.
    • APR DRG and OR procedure.
    • APR DRG for ECMO and presence or absence of certain OR procedures.
    • APR DRG and pairs of OR procedures.
    • APR DRG and principal diagnosis and non-O R procedure.
  • Compute the final patient severity of illness subclass based on the Phase 3 base patient severity of illness subclass and the Phase 3 severity of illness subclass modifications.

Return to Document

 

Page last reviewed March 2009
Internet Citation: Mortality Measurement: Development of the 3M™ All Patient Refined Diag. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/mortality/Hughesfig2-1.html

 

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care