DRG Workshop Belgrade, November Data Sets and the DRG grouper – RIC AND LINDY

DRG Workshop Belgrade, November 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, November Hospital funding schemes in other countries GERMANY – CASEMIX (DRG) PAYMENT - iNEK UK – (HRG) - PAYMENT BY RESULTS (PbR) USA – DRG – PROSPECTIVE PAYMENT SLOVENIA – DRG - SAME SERVICE SAME PRICE HONG KONG – P4P ABF = EPISODE PAYMENT =CASEMIX =PBR =PFP =DRG FUNDING..

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

DRG Workshop Belgrade, November DRG PERFORMANCE ELEMENTS (HK)

DRG Workshop Belgrade, November 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 CLINICAL TRIALS DATA COLLECTIONS

DRG Workshop Belgrade, November 2013.

DRG Workshop Belgrade, November ATS/PAS Data Concepts

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

DRG Workshop Belgrade, November 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, November Establishing the National Health Data Dictionary Long term project multiple users –Consensus governance complex and slow –Eg US HIPAA law e/index.html Can have special purpose variants based on and mappable to the core data.

DRG Workshop Belgrade, November 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, November Australia’s NHDD

DRG Workshop Belgrade, November Example of a Data element

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