Introduction to HRG4 Reference Cost Grouper

Presented byChris Knee Senior Information Analyst and

Peter Broughton Senior Casemix Consultant

Contents of this Session

Presentation on using the HRG4 Reference Cost Grouper

Demonstration of the key features of the HRG4 Reference Cost Grouper

Using the HRG4 Reference Cost Grouper

Chris Knee

Senior Information Analyst

Presentation Overview

What’s New

Data Preparation Required

Input Data

Output Data

Summary

Grouper Demonstration

What’s New – Part 1

3 in 1 - Report Generator and Spell Converter now integrated with the Grouper

The Grouper processes Spells and Episodes

User selects Trim Point Data

Unbundling – potential for output to contain more than one HRG per Episode and Spell

New code structure e.g. AA01Z not A01

Additional datasets can be processed e.g. Out-patient Attendance

What’s New – Part 2

Enhanced Data Validation

Mandatory fields validated before grouping (document – www.ic.nhs.uk/casemix/prepare)

Internal consistency checked during grouping

Any identified errors are grouped to HRG “UZ01Z Data Invalid for Grouping”

An error report is produced on run completion

For APC, if one of the Episode HRGs in a Spell is UZ01Z, then the Spell HRG is UZ01Z

Data Preparation – Part 1

Admitted Patient Care

Sorting The Input File must be sorted by Hospital Provider Spell

Number and then by Episode Number

Derived Items Age at Episode Start is required Episode Duration

Critical Care days need to be removed from Episode Duration (as in previous years)

Episode Duration should not be negative

Data Preparation – Part 2

Non-Admitted Patients

Sorting No sorting required

Derived Items Age at Attendance Date is required

Input Data Files – Part 1

Six datasets can be processed by the Grouper

Admitted Patient Care

Out-patient Attendance

Accident & Emergency

Adult Critical Care

Paediatric Critical Care

Neonatal Critical Care

Input Data Files - Part 2

As with previous Grouper

Two file formats can be processed CSV (Comma separated values) Fixed Width

For APC, input files must be at Episode level not Spell level

There are a number of mandatory fields specified in the Record Definition File

Record Definition File

As with the previous Grouper

The RDF tells the HRG Grouper where the mandatory fields are located within the Input File

The Grouper requires one RDF to be defined for each input dataset

The Grouper is supplied with sample RDFs

Users can define their own RDFs

Output Files

There are three Output Files

1. Main Output File

2. Error Report

3. Report File (replaces Report Generator)

Main Output FileIncluded within the Main File are

Original input data

Grouper derived fields

Spell HRG (repeated for each Episode) Spell Dominant Procedure Spell Primary Diagnosis Episode HRG Episode Dominant Procedure 0 or more Unbundled HRGs Episode Trim Point Episode Excess Bed Days Programme Budget Code

Note: Episodes assigned to UZ01Z are also included

Error Report File

Provides additional information for records in the Main Output File grouped to “UZ01Z Data Invalid for Grouping”

Report shows ALL errors for each record grouped to UZ01Z

Each record in the Error Report File will have a code and description of the error

Example Error Types

Invalid Primary Diagnosis Diagnosis does not exist / Not valid in primary position

Poorly Coded Primary Diagnosis Diagnosis exists and is valid but too unspecific to determine resource use

and group

Age Conflicting with Diagnosis E.g. Complications of pregnancy in a 5-year old child

Invalid Primary Procedure Procedure does not exist / Not valid in primary position

Poorly Coded Primary Procedure Procedure exists and is valid but too unspecific to determine resource use

and group

Age Outside Range 0 - 130 Years

www.ic.nhs.uk/casemix/prepare

Summary

What’s New

Input Data (including data preparation)

Output Data

Questions?

HRG4 Reference Cost Grouper Demonstration

Peter Broughton

Senior Casemix Consultant

Contents of Presentation

Pre-release software issues

Creating a Record Definition File

Single spell grouping

A selection of file grouping scenarios

Multiple Trauma – Review Trauma means non-superficial injury (e.g. broken

limb bone) Requirements

In the first episode of the spell: Primary diagnosis of trauma Another diagnosis of trauma from a different

trauma site (body is divided into nine areas)

Diag1 (trauma) Diag2 (non-trauma) Diag3 (trauma)

Non-Admitted Care HRG allocation is based on OPCS code E.g. Procedure H28.9 (Rigid Sigmoidoscopy) produces HRG

FB03A Endoscopic or intermediate large intestinal procedures 19 years and over

If no OPCS code, then HRG is WF01Z Non-Admitted Attendance

Multi-professional clinics identified by OPCS code X62.2 and X62.3 (HRG is WF02Z)

Diagnosis is ignored Where APC HRG is based on procedure, then the Non-

Admitted HRG will be the same for the same procedure(s) i.e. setting-independent

Where the APC HRG is influenced by diagnosis, the non-admitted HRG will be different

Emergency and Urgent Care

Uses A&E data HRGs are based on Investigation and Treatment

codes There are 11 HRGs

HRG4 Reference Cost Grouper Timetable 2007

1 April: HRG4 Grouper NHS UAT ends 20 April: HRG4 Grouper for Ref Costs released

1 March: HRG4 Grouper NHS UAT starts 19 March: HRG4 Grouper documentation:

overview, benefits, definitions, coding guidance

1 May: Dedicated Casemix helpdesk & triage commences

8 May: HRG4 trimpoints issued to NHS [FCE & Spells]

16 May: SHA/Nominated RC lead grouper training

Summary

Covered in this presentation: Creation of a user-defined Record Definition

File Grouping a single spell Processing of different data sets, requiring the

use of different Record Definition Files A variety of HRG types (APC, Non-Admitted,

Unbundling, CC, Splits, Multiple Trauma)

Questions