Financial risk, hospital cost, complications and comorbidities (CCc) in non-CC stratified urology diagnostic related groups

Issues concerning the on‐going care of patients with comorbidities in acute care and post‐discharge in Australia: a literature review

“…1991, Rutledge & Osler 1998). In addition, diagnosis related groups and clinical pathways that provide health services within the shortest possible timeframe (Schaldach 1997, Hovenga 1998) have often under‐estimated the actual length of stay required by patients with comorbidities (Munoz et al . 1988, Mushlin et al .…”

“…1992). Some authors state that the comorbidity has to be a medical problem (Munoz et al . 1988, Katz et al .…”

“…A further issue concerning the confusion over definition relates to the way in which the number of comorbidities per person has been counted in various studies. For example, comorbidities have been counted on admission (Greenfield et al . 1988, Munoz et al .…”

“…Little correlation has been found between the medically required length of stay and the expected length of stay based on diagnosis related groups, potentially placing quality of care at risk (Mushlin et al 1991, Rutledge & Osler 1998). In addition, diagnosis related groups and clinical pathways that provide health services within the shortest possible timeframe (Schaldach 1997, Hovenga 1998 have often under-estimated the actual length of stay required by patients with comorbidities (Munoz et al 1988, Mushlin et al 1991, Devo et al 1992, Schaldach 1997. Indeed, shorter lengths of stay reduce the exposure of patients to medical personnel limiting medical staff's opportunity to co-ordinate and manage the treatment of the patients' comorbidities.…”

“…Clearly, there is confusion in differentiating between a comorbidity, secondary diagnosis and complication when defining comorbidity (Greenfield et al 1988, Jencks et al 1988, Iezzoni et al 1992. Some authors state that the comorbidity has to be a medical problem (Munoz et al 1988, Katz et al 1996, Thomas 1997, not related to the primary diagnosis (Iezzoni et al 1992), chronic (Manton et al 1991, Iezzoni et al 1992, Librero et al 1999, Fillenbaum et al 2000, or inclusive of acute diseases (Feinstein 1970, Greenfield et al 1988, Thomas 1997, or a combination of acute and chronic diseases (Jones et al 1999, Librero et al 1999. Such ÔnondiseaseÕ entities' as pregnancy (Feinstein 1970), or curable states of health such as tinea and dental problems (Liu et al 1999), nosocomial infections and pressure sores (Greenfield et al 1988) have been considered to be comorbidities, whilst cancer has been excluded (Romano et al 1993).…”