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The individuals' identifiers were encrypted to protect privacy and confidentiality, and this study was approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.
The ACG system assigns all ICD-9-CM codes to one of 32 aggregated diagnostic clusters (ADGs). 21, 22 Each ADG is a grouping of diagnosis codes similar in terms of severity and likelihood of persistence of the health condition treated over a relevant period; ADGs are not mutually exclusive, and individuals can have up to 32 ADGs.
Individuals are then placed into 1 of 93 discrete ACG categories according to their assigned ADGs, age and sex. A standardized predicted resource index expresses anticipated resource use as a relative value, with the mean rescaled to one; higher value represents higher morbidity burden and thus higher medical utilization.