Applying the 3M All Patient Refined Diagnosis Related Groups Grouper to measure inpatient severity in the VA

To assess the severity level of acute inpatient care in the Veterans Health Administration (VA) using the 3M All Patient Refined Diagnosis Related Groups (APR-DRGs) Grouper and compare severity levels in the six study sites with other Veterans Affairs Medical Centers.

Acute inpatient stays were generated based on bedsection movement information in VA Inpatient Medical SAS data sets from federal fiscal years 1997 and 1998. All nonacute bedsections were excluded. The APR-DRG Grouper generated APR-DRG and severity level for each acute inpatient stay using relevant VA data in a fixed format. Severity and length of stay (LOS) within each major APR-DRG (those accounting for at least 0.5% of all acute inpatient stays or days) were compared between study sites and other centers using z scores.

Of 315 APR-DRGs, 63 major groups accounted for more than two thirds of all stays and days of care in both years. The study sites were similar in average patient severity and LOS to other centers for most APR-DRGs. For those with significant differences, the six centers had shorter LOS and higher severity. The magnitude of differences was large in LOS and small in severity.

The study sites are generally representative of the overall VA acute inpatient stays. Some adjustments were needed to reflect that the six sites had relatively sicker patients and lower LOS in some of APR-DRGs when resource utilization estimations in the six sites were generalized to the entire VA system. The severity measure of the 3M APR-DRG Grouper can be adapted to the VA controlling for the complicated nature of VA inpatient care.