"Asthma cases aren't all the same. This process allowed us to ensure that all asthma inpatients, no matter what their severity or what service they're admitted to, are treated appropriately from minute one of their stay, even if they arrive in the middle of the night and aren't seen immediately by a specialist," says co-author Samya Nasr, M.D., clinical director of pediatric pulmonology. "We were able to use the acuity-adjusted data to get the buy-in of all who treat asthma inpatients, and we found that the standard orders and documentation issues created a lot of discussion and interest."
Sedman emphasizes that what works in asthma care could also work for almost any condition that has an APR-DRG code. Already at Mott, the care of certain infectious diseases in children has improved because of changes made after a benchmarking against the NACHRI database. Nasr's team is doing the same for cystic fibrosis patients.
Adult services are also using the acuity-adjusted APR-DRGs -- UMHS chief of clinical affairs Darrell Campbell notes that APR-DRGs adjusted for the U-M's unique patient population are helping guide improvements in care at the main University Hospital. Campbell is senior author on the new paper.
"Before APR-DRGs, data on length and cost of patient stays was useful for hospital administrators who needed to plan and budget, but not appropriate for physicians and nurses who needed to redesign the way they delivered care," says Sedman. "Now, we have a tool that clinicians can use to look at their data after acuity level adjustments have been made, and to use in clinical redesign that's customized to their patients' acuity levels. We just need to encourage its use."