drg workshop belgrade, 18-22.november 2013. data sets and the drg grouper – ric and lindy

DRG Workshop Belgrade, 18-22.November 2013.

Data Sets and the DRG grouper –

RIC AND LINDY


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?


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 ..


Casemix Developmental ElementsCasemix Developmental Elements


DRG

PERFORMANCE ELEMENTS (HK)


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


ATS/PAS Data Concepts


PRIMARY CARE TYPE

AGE>70

PRINCIPAL INTENTION OF

CARE

FUNCTIONAL SCORE

<3

PDX CAT 1,2 OR 3

ADMITTED OR NON ADMITTEDCATEGORYSDX CAT

PROC CAT

DISPOSITION

COST DRIVERS


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


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/administrative/index.html

• Can have special purpose variants based on and mappable to the core data.


NATIONAL HEALTH DATA DICTIONARY

• KEY DATA ELEMENTS

• MINIMUM DATASET SPECIFICATIONS

• REPORTING REQUIREMENTS

• INTERNATIONAL AFFILIATION REFERENCES

• SUPPORTED BY – NATIONAL HEALTHCARE AGREEMENTS – PROVIDER CONTRACTS AND SLAs


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


Example of a Data element


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


INFORMATION SYSTEMS SCHEMA

SUPPLY HR FMIS PAS EHR

MPI

MHODS

AggregateAEDEMDESIS

MDSs

REPORTREPOSITORY

CUBESPIVOT

eg. COGNOS,BRIO, EXCELLeg. BUSINESS OBJECTSeg. SAS ,SPSS, STATA, ACCESS

BUSINESS LAYER

DATAWAREHOUSE

REPORTING LAYER (MIS)

STATISTICAL ANALYSIS

MHCMI

MHDW

eg. Oracle, SAP, etc

drg workshop belgrade, 18-22.november 2013. data sets and the drg grouper – ric and lindy

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