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Home › Resources › Glossary

Patient Classification Systems (Case-mix)

Wed, 04/30/2008 - 12:18 — Iasist

A Patient Classification System (PCS) is a system of rules that classifies each and every one of the patients seen by a health care provider into a collection of homogeneous groups (based on different attributes, among which is included the expected cost) from the basic information such as, age, sex, diagnoses and the procedures practised.

Although it is generally called patient classification, a good part of a PCS, particularly that linked to specialist care, classify into real health care episodes (discharges or outpatient clinic, for example)

The benefits of a tool capable of breaking down thousands of care episodes annually by a provider into a manageable case-mix group and clinically homogeneous categories have been shown to be of great use in all areas of planning and management from a double perspective.

Firstly, by characterising the typology of the episodes dealt with, PCSs allow the complexity of differences attributable to episodes dealt with by different providers to be known (and thus neutralised), and as a last resort, enabling equitable measures to be made of resource needs as well as the overall results observed in each of them.

On the other hand, the level of detail provided by the majority of PCSs also allows , from a clinical point of view, pin-pointing which health care processes in a hospital can be improved, compared to results observed in other hospitals using the same processes. From a micro-perspective, this potential of PCSs is the starting point of real management aimed at a specific product, insofar as it is able to attribute a group of key quality and health care efficiency indicators to that product.

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