AVG = Ambulatory visit group APG = Ambulatory patient group

1
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2
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Casemix system Developer Purpose No. groups variables
AVG Yale University broad class of outpatient office settings 571 Age, sex, diagnosis procedure
APG 3M HIS Prospective payment for ambulatory care visit 290 Diagnosis procedure
ACG Johns Hopkins University Risk-adjusted capitation payment 83 Age, sex, diagnosis
DCG Boston Brandeis, Health Economic Research For high cost groups 543 OP IP Diagnosis
ETG Symmetry Health Data Systems Entire episode of care for OP, IP, or both. 600 Diag/procedure, CC surgery, comorbidity
HCG DxCG group For elderly and chronic conditions 543 Diagnosis for OP IP, procedure
AVG Ambulatory visit group APG Ambulatory
patient group ACG Adjusted clinical group ETG
Episode treatment group DCG Diagnostic cost
group HCG Hierachical coexisting condition

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Ambulatory Patient Group (APG)
Ancillary APG
Source Averill RF, Goldfield NI, Gregg LW, Grant
T, Shafir B. Design and evaluation of a
prospective payment system for hospital based
outpatient care. Wallingford 3M Health
Information Systems 1995.
5
APG Payment System
(2) Ancillary Packing
APG 165 is therapeutic lower gastrointestinal
endoscopy APG 164 is diagnostic lower
gastrointestinal endoscopy APG 391 is simple
surgical pathology APG 349 is computerized
assisted tomography scan
Source Averill et al. Design of a prospective
payment patient classification system for
ambulatory care. Health Care Financing
Review 1993 15(1) 71-100.
6
Adjusted Clinical Group (ACG)

• Criteria used to assigned into ADG
• Persistence/recurrence over time
• - acute, recurrent, or chronic
• Severity of the condition
• - minor/major, stable/unstable
• Diagnostic / therapeutic procedures
• Etiology of the condition
• Specialty care involvement

- - - age, gender, specific ADG
Adjusted Clinical Groups (ACG)
7
???????? Aggregated Diagnosis Groups (ADGs)
Source Weiner JP, Abrams C, Forrest CB, Richards
TM, Starfield B, Tucker A. The Johns Hopkins
ACG casemix system software documentation
application manual version 4.5. Baltimore The
Johns Hopkins University School of Hygiene and
Public Health 2000.
8
??????????????????????? (Major ADGs)
Source Weiner JP, Abrams C, Forrest CB, Richards
TM, Starfield B, Tucker A. The Johns Hopkins
ACG casemix system software documentation
application manual version 4.5. Baltimore The
Johns Hopkins University School of Hygiene and
Public Health 2000.
9
Collapsed ADG (CADG)
Source Weiner JP, Abrams C, Forrest CB, Richards
TM, Starfield B, Tucker A. The Johns Hopkins
ACG casemix system software documentation
application manual version 4.5. Baltimore The
Johns Hopkins University School of Hygiene and
Public Health 2000.
10
ACG decision tree
Source JHU ACG Case Mix Adjustment System.
Version 7.0 (2005).
11
??????????????????????????? ?? 2545
APG ACG
All data (visit) 39.1 million 39.1 million
Grouping data (visit) 21.2 million (54) 18.2 million (47)
Reference codes 6,068 1,421
Number of groups 82 medical APGs 80 ACGs
Charge data (visit) 0.94 million 0.85 million (0.48 mil person)
Source Upakdee N. In 2nd International
Case-mix Conference, Malaysia 6-7 September, 2005
12
?????????????????? APG ??? ACG
Characteristics APG ACG
Diagnosis codes Yes Yes
Procedure codes Yes No
Age/sex No Yes
Requirement variable Significant procedure and ancillary codes Birth weight, delivered status
Unit of classification Visit Person
Payment Fee schedule Risk-adjusted capitation
Source Upakdee N. In 2nd International
Case-mix Conference, Malaysia 6-7 September, 2005
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?????????????? Adjusted Clinical Group

• Describe population health (epidemiology)
• - By number of ADGs
• - By resource utilisation band (RUB)
• - By disease specific prevalence (EDCs)

• Disease management and case management
• - Target interventions toward higher risk group
  i.e. cancer
• - High risk case identification i.e. high cost
  case
• - Performance evaluation
• - Population based funding system

• Profiling resource use
• - By comparing actual expected resource
  utilisation

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Example of assigning a patient to an ACG
Patient A
Patient B
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• ?????????????????????? Adjusted Clinical Group
  (ACG)
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• - ????? major ADG, ?????????? ADGs
• - ????? ACG

Source Weiner JP, Abrams C, Forrest CB, Richards
TM, Starfield B, Tucker A. The Johns Hopkins
ACG casemix system software documentation
application manual version 4.5. Baltimore The
Johns Hopkins University School of Hygiene and
Public Health 2000.
16
?????????.???????? major ADGs
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(Adjusted Clinical Group) ????????????????????????
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17
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(Adjusted Clinical Group) ????????????????????????
??????????? ????????????????????????.
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????? major ADGs lt 1
???????????????????????????????? (ACG)
????? major ADGs gt 1

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