Journal of
Public Health and Epidemiology

  • Abbreviation: J. Public Health Epidemiol.
  • Language: English
  • ISSN: 2141-2316
  • DOI: 10.5897/JPHE
  • Start Year: 2009
  • Published Articles: 655

Full Length Research Paper

The ability of the all patient refined (APR) and centres for medicare (CMS) diagnosis related groups (DRG) systems to evaluate clinical and functional outcomes of hospitalized elderly patients: A multicentre, prospective study

Alberto Pilotto1, Marilisa Franceschi2, Mauro Di Bari3, Franco Rengo4, Roberto Bernabei5, Luca Lorenzoni6, Niccolò Marchionni3 and Antonio Greco2*
1Geriatric Unit ULSS 16, S. Antonio Hospital,Padua,and Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG) Italy. 2Geriatric Unit IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy. 3Unit of Gerontology and Geriatric Medicine, Department of Critical Care Medicine and Surgery,University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 4Geriatric Unit, University “Federico II”, Napoli, Italy. 5Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy. 6 Health Department, Organisation for Economic Co-operation and Development, Paris.
Email: [email protected]

  •  Accepted: 11 May 2011
  •  Published: 30 June 2011


Aim of the study was to compare the ability of the all patients refined diagnosis related groups (APR-DRG) with the centre for medicare and medicaid services diagnosis related groups (CMS-DRG) in predicting multidimensional impairment of elderly patients. Cases discharged from 20 geriatric units were grouped by the CMS-DRG and the APR-DRG. A comprehensive geriatric assessment (CGA) was performed using the activities of daily living (ADL), instrumental activities of daily living (IADL), short portable mental status questionnaire (SPMSQ), comorbidity index rating scale (CIRS), mini nutritional assessment (MNA), geriatric depression scale-short form (GDS-SF) and exton smith scale (ESS). Number of drugs at admission (DPA) and length of stay (LOS) were also recorded. CMS-DRG and APR-DRG relative weights (RW) were used for comparisons. 1273 patients were included. With increasing the APR-DRG-RW, a significant increase in the prevalence of impaired patients was found in ADL, IADL, SPMSQ, CIRS, GDS-SF and ESS. The CMS-DRG-RW subgroups showed a significant difference for MNA and GDS-SF. LOS was significantly different for both APR and CMS DRG. The number of CGA domains in which APR showed a more significant trend in disability when compared to CMS DRG demonstrates that the former was a better predictor of multidimensional impairment.


Key words: All patients refined diagnosis related groups (APR-DRG), centre for medicare and medicaid services diagnosis related groups (CMS-DRG), comprehensive geriatric assessment, elderly.