{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:28:32Z","timestamp":1762507712938,"version":"3.38.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T00:00:00Z","timestamp":1556668800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HIM J"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> The All Patient-Refined Diagnosis-Related Groups (APR-DRGs) system has adjusted the basic DRG structure by incorporating four severity of illness (SOI) levels, which are used for determining hospital payment. A comprehensive report of all relevant diagnoses, namely the patient\u2019s underlying co-morbidities, is a key factor for ensuring that SOI determination will be adequate. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective:<\/jats:title><jats:p> In this study, we aimed to characterise the individual impact of co-morbidities on APR-DRG classification and hospital funding in the context of respiratory and cardiovascular diseases. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> Using 6 years of coded clinical data from a nationwide Portuguese inpatient database and support vector machine (SVM) models, we simulated and explored the APR-DRG classification to understand its response to individual removal of Charlson and Elixhauser co-morbidities. We also estimated the amount of hospital payments that could have been lost when co-morbidities are under-reported. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> In our scenario, most Charlson and Elixhauser co-morbidities did considerably influence SOI determination but had little impact on base APR-DRG assignment. The degree of influence of each co-morbidity on SOI was, however, quite specific to the base APR-DRG. Under-coding of all studied co-morbidities led to losses in hospital payments. Furthermore, our results based on the SVM models were consistent with overall APR-DRG grouping logics. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion and implications:<\/jats:title><jats:p> Comprehensive reporting of pre-existing or newly acquired co-morbidities should be encouraged in hospitals as they have an important influence on SOI assignment and thus on hospital funding. Furthermore, we recommend that future guidelines to be used by medical coders should include specific rules concerning coding of co-morbidities. <\/jats:p><\/jats:sec>","DOI":"10.1177\/1833358319840575","type":"journal-article","created":{"date-parts":[[2019,5,2]],"date-time":"2019-05-02T03:08:07Z","timestamp":1556766487000},"page":"47-57","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Importance of coding co-morbidities for APR-DRG assignment: Focus on cardiovascular and respiratory diseases"],"prefix":"10.1177","volume":"49","author":[{"given":"Julio","family":"Souza","sequence":"first","affiliation":[{"name":"Faculty of Medicine of the University of Porto, Portugal"},{"name":"CINTESIS \u2013 Center for Health Technology and Services Research, Portugal"}]},{"given":"Jo\u00e3o Vasco","family":"Santos","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of the University of Porto, Portugal"},{"name":"CINTESIS \u2013 Center for Health Technology and Services Research, Portugal"},{"name":"Public Health Unit, ACES Grande Porto VIII \u2013 Espinho\/Gaia, Portugal"}]},{"given":"Veronica Bolon","family":"Canedo","sequence":"additional","affiliation":[{"name":"Faculty of Informatics of the University of A Coru\u00f1a, Spain"}]},{"given":"Amparo","family":"Betanzos","sequence":"additional","affiliation":[{"name":"Faculty of Informatics of the University of A Coru\u00f1a, Spain"}]},{"given":"Domingos","family":"Alves","sequence":"additional","affiliation":[{"name":"CINTESIS \u2013 Center for Health Technology and Services Research, Portugal"},{"name":"Ribeir\u00e3o Preto Medical School of the University of S\u00e3o Paulo, Brazil"}]},{"given":"Alberto","family":"Freitas","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of the University of Porto, Portugal"},{"name":"CINTESIS \u2013 Center for Health Technology and Services Research, Portugal"}]}],"member":"179","published-online":{"date-parts":[[2019,5,1]]},"reference":[{"key":"bibr1-1833358319840575","unstructured":"Administra\u00e7\u00e3o Central do Sistema de Sa\u00fade (2014) Agrupador de GDH all patient refined DRG. 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