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" E MIX DEFINITION BY DRG Mi js1 - 44 - Y ) is the mean value of the dependent variable in the kth group. The total within group sunm of squares (TWGSSQ) for the G groups is the sum of the total squared deviations of each grotip's observations froin the respective groupl meian and is given by TWGSSQ (G) = G Y,,= i R i¡ Rt M1, ' (Y" -- Yk,) j=! For a given independent variable, the CLASSIFY algorithm partitions observations into the particular set of groups that results in the uminimization ofTWCSSQ for a specific dependent variable. Since TWGSSQ is proportional to the variance left unexplained by the independent variable, minimization of TWGSSQ results in the miniiiiization of the unexplained variance of the data. 2.3 DRG Formation from Major Diagnostic Categories To facilitate the analysis over the wide range of disease conditions in the acutecare setting all diagnoses were initially divided int.i 83 mutually exclusive and exhaustive Major Diagnostic Categories. Their formation was also motivated to insure diagnostic hornogeneity. Thus, the final clusters do not contain patients that transcended these categories. For example, from the point of view of output utilization, it may be appropriate to form a patient class with hemorrhoíds, hypertrophy of tonsils, and normal delivery. The ou" ut utilization of these patients is very similar, often ret,s.`ring a relatively minor surgic.l procedure with a very short preoperative stay and a total hospitalization period of 2 1. iE Rk (2.5) MiEDICAL CAIIE or 3 days. However, the physicians who would treat these patients as well as the treatment processes of the problems they! are presenting are quite diflerent. Therefore, it was felt that including such pati.iats ill the samine class would not define a nedlically> meaningthl category. The specification of the Major Diagnos. tic Categories wvas peirforíied by al coiniittee of clinicians, tollowing 3 general principles: 1. Major Diagnostic Categories miust have consisteiicy ii ternus oftleira iilt(llie. phvsiop.atho>logic classificaitiotn. or in tlht. maiutier in which tlihey are cliniícally ma.iaged. 2. iMaijor Diagnostic Categories ¡must have a siulicient iinuiber of patients. 3. Major Diagnostic Categories mniust cover the complete range of codes withouit overlap. A list ofthese categoríes as de'ined by their ICDA8 and HICDA2 codes appears in Table 1. There is also an indication of the corresponding Professiohal Activity Study (PAS) diagnosis groups that correspondl to each category. Note that the categories are very broad, such as Diseases of the Eye. Diseases of the Cardiovascular System aud Infectious Diseases.. A consistent process was followed in partitioning each Major Diagnostic CategorY into DRGs. First of all, each category was refined by eliminating certain unwanted observations. Cases with dead patients or bad records, and those that were particiularly deviant, were excitided ironi tiirIIILr' analysis. Cases with dead patients were removed trom consideration since thleir lengths of stay were probably atypical of the disease or problemni under consi(lerai tion. Records with olbviois coding errors or missing data were also eliminated because their information could be misleading. Ob-
Vol. XVIII, No. 2, Supplenent - 45 - TABLE 1. Major Diagnostic Categories DRC CONSTRUCTION Mijor PAS lIDAS HICDA2 Category Initial Grotup Nainies G Crollp No. Codes (odes 1 Infectious Diseases 1-8, 10-17 000-0689, 071-1360 2 3 4 5 6 Malignant Neoilasmi of Digestive System Mlalignlnt NS'eolasmi of Respirato
Page 1 and 2: L 00111111 MASTER COPY - NO TOCAR B
Page 3 and 4: - ii - liancock, W., D. Magerlein y
Page 5 and 6: FOREWORD These last years, PAHO wit
Page 7 and 8: Workshop .- Education in Operationa
Page 9 and 10: -3. The format of the workshop was
Page 11 and 12: -5- 2. Programs for bringing togeth
Page 13 and 14: II. R.commendations -7- A series of
Page 15 and 16: -9- there are technically trained i
Page 17 and 18: -11- and selected individuals who h
Page 19 and 20: -13- 6. In order to improve the qua
Page 21 and 22: -15- cnve!opment will typically be
Page 23 and 24: -17- 16. All participants sbould pr
Page 25 and 26: A. Short Courses -19- Short courses
Page 27 and 28: -21- 4. Presentation of a case to b
Page 29 and 30: Topic Introduction to Systems Analy
Page 31 and 32: -25- 12. Elementary Statistics ior
Page 33 and 34: -27- 8. Applications of data proces
Page 35 and 36: -29- problems. The graduate should
Page 37 and 38: -31- Lblo-w. Also given is that typ
Page 39 and 40: - 33 -' -Case Mix Definition by Dia
Page 41 and 42: - 35 - Acknowledgment The authors w
Page 43 and 44: ML ICAL CAE1 Februurl 1980, Vol. XV
Page 45 and 46: X;' VIII, No. 2. Suippllce,t - 39 -
Page 47 and 48: - 41 - dMLDICAL C.ARE '.Fcbrtanj 19
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Page 63 and 64: - 57 - MEDICAL CARE Febiuary 1980,
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- 99 - 420 R. MFRIlC}IS AND J. PRAW
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V - 101 - McUCi. (:Au AWuu IMI. VoL
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GREENLAND ET AL - 103 - the case (p
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CREENLAND iT AL - 105 - TABLE 2. Fi
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GREENLAND ET AL. 3. Cornfleld J, Ha
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160 I indicates the flow of patient
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162 CONGESTION POINTS ANU CONTROL.A
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164 c 8o Table 4. The cffect of cha
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166 B. LEV etal. significant differ
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MEREDITH - 117 - ciety. However. ch
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I MEREDITH - 119 - varying oulcome
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MEDICAL CARE ,arch 1981, Vol. XIX,
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%,I. XIX, No. 3 iclnts. It should d
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n'ol. XIX, No. 3 - 125 - tailed exa
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1 Vol. XIX. No. 3 - 127 - tant for
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Vi. .XIX, No. 3 - 129 - tom' s reco
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- 131 - A \ ,,1. XIX, No. 3 PEHFOHR
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V Xl. IX, No. 3 - 133 - PERFORMANCE
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- 135 - The fourth requirement is l
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- 137 - Systems and Procedures of P
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- 139 - 2. ldentify problemn areas
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c 1 '-a
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u. o a.- 1 W. LZi - 143 - c c S C.
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- 145 - Thc cu rrent appointmren t-
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- 147 - A pure block appointment sy
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- 149 - ihe future. It was discover
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- 151 -
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- 153 - Figui.'¢ VII. Patient Arri
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- 155 - sonnel working in positions
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- 157 - 17. Keep the time span of t
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- 159 - TABLE I: Pnmary DesklConsul
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.Recomme;tded systenz - 161 - .;any
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- 163 - system, there is nr'. :vste
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- 165 - - A major problem with such
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- 167 - T1c Iteole of Olieraionls R
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- 169 - Larry J. Shumc- Harvey Wolf
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- 171 - '- ionoal Heolth Ploanning
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- 173 - Regional Health Planning ar
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- 175 - Regio.,oi Health Planning w
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- 177 - Regionao rfeclth Planning l
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A^CJonoal neonah ronning 21. 1'. F.
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- .,1 - Programming, Budgeting, and
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- 183 - the health care industí ,
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- 185 - was apparently no scarcity.
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ut, u a. íL ._c E 0 t42 a .. 0m u
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plex stochastic distribution of arr
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- 191 cumulated according to any or
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- 193 - Step 2 represents the heart
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ÍA en .aa
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- 197 - analysis, forecasting, and
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Budgeting Attitudes - 199 - The pla
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- 201 Health Services Research most
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a. - 203 - Health Services Research
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- 205 - DESIGN OF ALTERNATIVE PROVI
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- 207 - 1. A change in the immigrat
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- 209 - accessibility of health car
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- 211 - dimensional graph to illust
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- 213 - Primary Care Health Service
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- 215 - different health and educat
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- 217 - The tasks that were rated "
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IC1 o -a - i - w im W..i C -J M. -
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0 z 0 u _ I- 0 Ut. I,, uj CD Q U- ,
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TABLE 3 TASK ANALYSIS OF MALNUTRITI
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11 - 225 - TASK ANALYSIS OF MALNUTR
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- 227 - 12. Reisman, A., F.Staub, B
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- 229 - METHODS Parameters Affectin
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- 231 - ~HNCOCK Fig. 1. Daily censu
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- 233 - HANCOCK Table 1. Parameters
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- 235 - Fig. 3. Maximum average occ
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- 237 - HANCOCK ET AL Fig. 4. Maxim
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- 239 - AECOCL. Table 2. Eflect of
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- 241 - HANCOCK Discussion ET AL Th
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#12 Estinating the Need for Additio
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Pri c= arvicc a ia Indina. - 245 -
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. 1' - - IIINDLE Algorithmn for Det
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- 249 - HINDLE that all tlie primar
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- 251 - HINDLE 6. Computc Mhe Avail
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- 253 - HINDLA Tablek Meamm of Zfic
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HINDLE Tr AL HIALTH falvCU - 255 -
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- 257 - HIiDLZ 26. Ado, An . ad L.
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- 259 - REISMIAN, DEAN, ESOOBUE, AG
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- 261 - REISMAN, DEAN, ESOGBUE, AGG
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- 263 - 1350 REISMiAN, DEAN, ESOOBU
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- 265 - REISMAN, DEAN, ESOOBUE, AGO
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- 267 - 1354 REISMAN, IEAN, ESOGCUE
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- 269 - William J. Abernothy and Jo
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- 271 - William J. Abernathy and Jo
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- 273 - William 1. Abernothy ond Jo
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- 275 - William J. Abrnarthy and Jo
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- 277 - William J. Abernathy and Jo
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- 279 - William J. Aberncthy and Jo
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- 281 - 642 William J. Abernathy an
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Decmand in Mintu és/Day Numnlber o
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Disposal System 326 IIstlic I,',i,
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i Trays 334 Colorful pattenis anid
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tiie, gency L:ghting 347 ,i',., .:.
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- 296 - REVEI.LE we believe to be t
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- 293 R£VELLE is apparent in light
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- 295 - REVEt.EI. ET AL. poSJcd pro
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- 297 - RM.VELLE EL AL. of faciliti
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REVELLE ET AL. HALTOI SERVICUS RESE
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REVELLE ET Al.. - 301 - Fig. 4. Ano
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- 303 - REVet. ¡T AL Act of 1973.
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- 305 - REVELLE possible within ilh
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- 307 - RLVELI.E 29- Khumawala. a.
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- 309 - assuring thal the maxinmum
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-311 - the implemented strategy he
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- 313 - analytical approximalions w
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- 315 - rcquired Ior shipping and o
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- 317 - Controlling ¡he system The
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- 319 - The light pen techniques ar
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- 321 - shipnients have to be on ro
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- 323 THE CREATER NEIW' YORK BLOOD
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_,~ .- - 3. 2- - TABLE 1. PATIENT C
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TABLE 3. MEDICAL INTENSIVE CARE UNI
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Nursing Stalf Level (i of nurss/day
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Table 1. Factors ¡i denad for medi
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e forecast. This section descijbcs
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ei, paid to these standards in cond
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O Emphasis u.on the explicit enumer
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*1 1 21 1 «i 1 1 1 1 - 331, -- For
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Therc are ihreec basic prcessecs fi
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- 343 - Forecasting Hcalth Care Ser
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#20 Jaime 1B. Henrs Rtxlnc. I.. Ro:
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- 347 - I v,'N ti.K 1tHm.pi.l !, t1
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Ra.fo.renem.. aid %.hs '. - 31!9 -
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; / larman u empirical research has
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I Klarman - >3 - benefits that for
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I Klaman Ctitena for Inchmion - 355
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IClarman - 37 - The prevailing tend
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1 Klarman Intargibl Benefits - .5 -
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Kllarman - 361 - thi prospects of r
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- 363 - Thua, it did not consider w
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I Klannan - 365 - again if the new
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Klarman - 367 - At the other pole,
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- 369 - seem worth exploring. Howev
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iKlarman - 371 - in the use of serv
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Kmnnan - 373 - REFERENCES 1. Havema
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- 375 - 59. Valr y, W. S. One eonoi
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- 377 - i aSll a _ . b, CuaMu L. L,
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WAHRNER ANI) I|UTTr)N The puroses I
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WARNER AND HUTfON - 381 - observers
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.AHNF:R AND IIl'TIoN - 383 - rare I
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WARNER AND HUTTrU., TABLE 1. Trenda
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W'AHNER AND IHUTTON - 387 - treatme
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AAHNER AND HU'TON - 389 - Several d
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WARNER AND HUTTON pal orientations
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w'ARNER AND UL'TTOit'u ' . N Engl I
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I,,qr *ir 'ilu.,i XV. Seplteri¡br
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In.lumin- i',)i.eIu XV. Seph.irhb'r
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In#unrvlVolutn XV. September 1978 h
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Problemas identificados - 401 - Dur
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Programas educativos 3 - 403 - 1. S
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- 405 - maestrfa, donde se supone q
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- 407 - presentación formal de inf
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- 409 - * Curso para ingenieros ind
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- 411 - ¢ 16. Hancock, W., D. Mage
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- 413 - 2. Barrenechea, J. J. La se
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- 415 - Curwso (8 a 16 horas) para
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- 417 - 4. Necesidades de los admin
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MOISES ARTEAGA DR. DAVID GOMEZ COVA
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