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Classifying Clinical Pathways MIC 2004 Brussels 25/11/2004 L. De Bleser Prof. Dr. W. Sermeus Dr. J. Vlayen K. Vanhaecht Centre for Health & Nursing Research,

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Presentation on theme: "Classifying Clinical Pathways MIC 2004 Brussels 25/11/2004 L. De Bleser Prof. Dr. W. Sermeus Dr. J. Vlayen K. Vanhaecht Centre for Health & Nursing Research,"— Presentation transcript:

1 Classifying Clinical Pathways MIC 2004 Brussels 25/11/2004 L. De Bleser Prof. Dr. W. Sermeus Dr. J. Vlayen K. Vanhaecht Centre for Health & Nursing Research, KULeuven, Belgium Contact :

2 Introduction (1) Definition clinical pathway Schedules of medical and nursing procedures, including diagnostic tests, medications, and consultations designed to effect an efficient, coordinated program of treatment. (From Mosby's Medical, Nursing & Allied Health Dictionary, 4th ed)

3 Introduction (2) International Classification of Diseases 9th revision, Clinical Modification (ICD9-CM) –Classification of mortality & morbidity data –Section for diagnostic & procedure codes –12 000 different codes for diagnosis, 3 500 codes for procedures –Several codes/patient

4 Introduction (3) Clinical Coding System (CCS) –Grouping of diagnosis and procedures –Clinical grouper of ICD-9 CM codes –2 related classification systems (single- and multi-level) –N (single-level): diagnosis: 259; procedures: 231 –Several codes/patient

5 Introduction (4) Example of single-level CCS procedure categories –ICD9-CM codes 36.10, 36.11, 36.12, 36.13, 36.14, 36.15, 36.16, 36.17, 36.19, 36.2, 36.3, 36.31, 36.32, 36.39 are categorized in CCS-code 44. = Coronary Artery Bypass Graft (CABG)

6 Introduction (5) All Patient Refined Diagnosis Related Groups (APR-DRG) –Classifies patients based on common characteristics (diagnosis, treatment, age, consumption of resources and LOS) –355 different categories –Subdivision according to Risk Of Mortality (ROM) and Severity Of Illness (SOI) –One group/discharged patient

7 Methodology Data collected between 01/2002 and 06/2003 13 surgical clinical pathways (total hip arthroplasty (2), total knee arthroplasty, cataract, mammary carcinoma, ALIF, ACIF, low back surgery, intracranial tumors, maxillary surgery, radical prostatectomy, abdominal hysterectomy, caesarean section) 412 patients ICD9-CM, CCS codes, APR-DRG

8 Results: all codes Clinical pathwayNICD9-CMCCSAPR- DRG Total hip arthroplasty42221 Total knee arthroplasty3722131 Cataract97743 Mammary carcinoma11247328 Total hip arthroplasty7331 ALIF15431 ACIF15221 Low back surgery15321 Intracranial tumors15771 Maxillary surgery161281 Radical prostatectomy11991 Abdominal hysterectomy1517143 Caesarean section151071

9 Results: principal codes Clinical pathwayNICD9-CMCCS Total hip arthroplasty4211 Total knee arthroplasty3721 Cataract9731 Mammary carcinoma11252 Total hip arthroplasty711 ALIF1511 ACIF1511 Low back surgery1511 Intracranial tumors1511 Maxillary surgery1621 Radical prostatectomy1111 Abdominal hysterectomy1511 Caesarean section1511

10 Results: Severity Of Illness Clinical pathwayNCategories Severity Of Illness 1234 Total hip arthroplasty42231711 Total knee prosthesis3727 91 Cataract9780161 Mammary carcinoma11259521 Total hip arthroplasty77 ALIF15123 ACIF15123 Low back surgery15132 Intracranial tumors1521111 Maxillary surgery16 Radical prostatectomy1192 Abdominal hysterectomy1587 Caesarean section15861 Total 412276109243

11 Results: Risk Of Mortality Clinical pathwayNCategories Risk Of Mortality 1234 Total hip arthroplasty42301011 Total knee arthroplasty37361 Cataract97943 Mammary carcinoma11210561 Total hip arthroplasty77 ALIF15 ACIF15 Low back surgery15 Intracranial tumors152931 Maxillary operation16 Radical prostatectomy1192 Abdominal hysterectomy1513 2 Caesarean section15 Total 4123723172

12 Discussion (1) Many ICD9-CM codes per clinical pathway Grouping principal coding by CCS: less variation Strong relationship between clinical pathways and APR-DRG However 1/4 CP is classified in more than 1 APR-DRG

13 Discussion (2) CPs are classified prospectively. DRGs are coded retrospectively (advantage for CCS) Possible relationship CP & APR-DRG: –CP = APR-DRG –CP < APR-DRG –CP > APR-DRG Relationship CP & ROM / SOI Limitation: small number of patients in some CPs

14 Conclusion Rather high heterogeneity when classified with ICD9-CM, CCS or SOI More homogeneous results with APR-DRG and ROM Homogeneous results for CCS when restricted for principal codes (diagnosis or procedure) Relationship between clinical pathways and CCS or APR-DRG has to be refined in larger studies

15 References Agency for Healthcare Research and Quality (AHRQ). Clinical Classificiation Software 2004. 1-16. 2004. Maryland, HCUP. Anderson, K. (2000). Mosby's Medical, Nursing & Allied Health Dictionary. (W B Saunders) Bardsley, M., Coles, J., and Jenkins, L. (1989). DRGs and Health Care: The management of case mix. (King Edward's Hospital Find for London: London.) Coffey, R. J., Richards, J. S., Remmert, C. S., LeRoy, S. S., Schoville, R. R., and Baldwin, P. J. (1992). An introduction to critical paths. Qual.Manag.Health Care 1, 45-54. Glauber, J. H., Farber, H. J., and Homer, C. J. (2001). Asthma clinical pathways: toward what end? Pediatrics 107, 590-592. Practice Management Information Corporation (1998). International Classification of Diseases 9th Revision, clinical modification, fifth edition. (PMIC: California.) Sermeus, W. (2003). De Belgische ziekenhuisfinanciering ontcijferd. (Acco: Leuven.) Sermeus, W., Ramaekers, D., Aertgeerts, B., Demeulemeester, E., Vlayen, J., and De Bleser, L. Tussentijds BOS-rapport Klinische Paden. 1-245. 2004. Leuven, unpublished work. Vanhaecht, K, Sermeus, W., Vleugels, A., and Peeters, G. (2002). Ontwikkeling en gebruik van klinische paden (clinical pathways) in de gezondheidszorg. Tijdschrift voor Geneeskunde 58, 1542-1551.

16 Acknowledgment This project is supported and funded by the Belgian federal Ministry of Public Health, Safety of Food Chain and the Environment.

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