APRDRG

APRDRG stands for All-Patient Refined Diagnosis Related Groups. It is a hospital patient classification system used for inpatient payment, reporting, and outcome analysis. The APRDRG approach extends traditional DRGs by incorporating patient complexity through two refinement dimensions: severity of illness (SOI) and risk of mortality (ROM). Each discharge is categorized into a base DRG and then subdivided into four levels of SOI and four levels of ROM, providing a more granular view of resource use and clinical risk.

Classification mechanism: The system uses principal diagnosis, procedures, and secondary diagnoses to determine a base DRG. It then assigns SOI and ROM levels, creating a final APRDRG code that combines the base DRG with the two refinement dimensions. The four SOI levels typically range from minor to extreme, while the four ROM levels range from low to extreme, allowing hospitals and payers to compare cases with similar complexity more fairly.

Development and use: APRDRG was developed by 3M Health Information Systems in the 1990s and has since been adopted in various countries and by multiple payers as an alternative or complement to other DRG systems. It relies on coded clinical data, usually ICD-9-CM/ICD-10-CM diagnosis codes and ICD-PCS procedure codes, and is available in versions that align with updated coding schemas. The system is proprietary and licensed for implementation.

Applications and limitations: APRDRG is used for prospective payment calculations, risk-adjusted benchmarking, quality reporting, and research. Its effectiveness depends on accurate and complete coding; differences between versions and the proprietary nature of the system can pose challenges for standardization and cross-institution comparability.