Data Sets and the DRG grouper RIC AND

Data Sets and the DRG grouper – RIC AND LINDY DRG Workshop Belgrade, 18 -22. November 2013.

WHY? ? ? • What are the data to be used for? • What observations are needed? • What data items are able to be retrieved? – How easy are they to abstract? – How consistent are they? – How comprehensive is the collection? • Are valid? - relevant to the purpose? • How reliable? - why are they recorded? DRG Workshop Belgrade, 18 -22. November 2013.

Hospital funding schemes in other countries • • • GERMANY – CASEMIX (DRG) PAYMENT - i. NEK UK – (HRG) - PAYMENT BY RESULTS (Pb. R) USA – DRG – PROSPECTIVE PAYMENT SLOVENIA – DRG - SAME SERVICE SAME PRICE HONG KONG – P 4 P ABF = EPISODE PAYMENT =CASEMIX =PBR =PFP =DRG FUNDING. . DRG Workshop Belgrade, 18 -22. November 2013.

Casemix Developmental Elements ABF Elements Admitted Acute Emergency Care Sub-acute Care Mental Health Outpatient Care Product ID & Classification Counting Costing Data Management, Analysis & Reporting Funding Governance & Management DRG Workshop Belgrade, 18 -22. November 2013. Hospital auspiced CHS Community service obligations Teaching Training & Research

PERFORMANCE ELEMENTS (HK) DRG Workshop Belgrade, 18 -22. November 2013.

DATA COLLECTIONS • ACTIVITY DATA COLLECTIONS – Billing • Fee for service claims datasets • episode of care datasets – ‘Morbidity’ datasets • All activity from a provider datasets • Particular specialty area data • Particular phase of care or care-type data • COSTING DATA COLLECTIONS DRG Workshop • CLINICAL TRIALS DATA COLLECTIONS Belgrade, 18 -22. November 2013.

DRG Workshop Belgrade, 18 -22. November 2013.

ATS/PAS Data Concepts DRG Workshop Belgrade, 18 -22. November 2013.

COST DRIVERS SDX CAT PROC CAT ADMITTED OR NON ADMITTED CATEGORY AGE >70 PRINCIPAL INTENTION OF CARE PRIMARY CARE TYPE DISPOSITION PDX CAT 1, 2 OR 3 FUNCTIONAL SCORE <3 DRG Workshop Belgrade, 18 -22. November 2013.

The National Minimum Data Set • One reporting requirement multiple uses • Complex process to maintain • Stable and rigorous standards – but variable compliance • Consistent and valid for comparisons • Alternative is required DSS for payment. • Convenient to maintain with NHDD DRG Workshop Belgrade, 18 -22. November 2013.

Establishing the National Health Data Dictionary • Long term project multiple users – Consensus governance complex and slow – Eg US HIPAA law • http: //www. hhs. gov/ocr/privacy/hipaa/administrativ e/index. html • Can have special purpose variants based on and mappable to the core data. DRG Workshop Belgrade, 18 -22. November 2013.

NATIONAL HEALTH DATA DICTIONARY • • KEY DATA ELEMENTS MINIMUM DATASET SPECIFICATIONS REPORTING REQUIREMENTS INTERNATIONAL AFFILIATION REFERENCES • SUPPORTED BY – NATIONAL HEALTHCARE AGREEMENTS – PROVIDER CONTRACTS AND SLAs DRG Workshop Belgrade, 18 -22. November 2013.

Australia’s NHDD http: //www. google. com/search? client=safari&rls=en&q=national+health+data+dictionary+version+15&ie=UTF-8&oe=UTF-8 DRG Workshop Belgrade, 18 -22. November 2013.

Example of a Data element DRG Workshop Belgrade, 18 -22. November 2013.

Data collection and reporting • Using downloads from hospital Patient Administration Systems (PAS) • Coding from clinical records and discharge summaries to PAS • Web interfaced data entry systems • Online edit and audit functions • Data warehousing and data access • Metadata management functions DRG Workshop Belgrade, 18 -22. November 2013.

INFORMATION SYSTEMS SCHEMA eg. SAS , SPSS, STATA, ACCESS eg. BUSINESS OBJECTS eg. COGNOS, BRIO, EXCELL REPORT REPOSITORY STATISTICAL ANALYSIS AED EMD ESIS Aggregate CUBES PIVOT MH DW MDSs eg. Oracle, SAP, etc SUPPLY REPORTING LAYER (MIS) DATA WAREHOUSE MH ODS MH CMI MPI HR FMIS DRG Workshop Belgrade, 18 -22. November 2013. PAS EHR BUSINESS LAYER