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Nursing Related Groups and Hospital Financing Diegem - September 16, 2014

Marie-Laurence de Lannoy

Luc Van Aken




Agenda

NRG definition

Assignment of NRG to Nurse Care Periods (NCP’s)

Relative Weigths

Market Share




Abreviations

NCP = Nursing Care Period / Zorgepisode / Episode de soin

NRG = Nursing Related Group

PI = Principal Indicator

SI = Secondary Indicator




NRG definition Nurse Care Profile per NRG




Nurse Care Periods (NCP) – 3 groups

24 hour NCP

< 24 hour NCP without transfers

< 24 hour NCP – transfer

NRG’s for

24 hour NCP’s – 20 NRG’s

< 24 hour NCP’s – 11 NRG’s

For < 24 hour NCP’s – transfer : both groups of NRG’s are applicable (differentation in

Relative Weight)

NRG definition




An NRG is the Nurse Care Profile for a selected group of NCP’s in comparison

with the Global Nurse Care Profile

Global Nurse Care Profile per group of NCP’s (24 hour NCP / <24 hour NCP) is calculated

Selections of NCP’s are defined (see next slides)

The Nurse Care Profile is calculated for each selection of NCP’s

For these selections of NCP’s the Nurse Care Profile is compared with the Global Nurse

Care Profile

Use of the RIDIT methodology to define the Nurse Care Profiles and to compare them

NRG definition




24 hour NRG’s

Prefix nurse unit Main bedindex Other parameter NRG

INT CI, DI, HI 1- intensive care

INT EI Age 2- intensive care pediatrics

INT NI Age 3- intensive care neonatology

BRU BR 4- care for complicated wounds

DIV AR, OB Age 5- obstetrics care

DIV M Age 6- maternity care (mother)

DIV MI Age 7- intensive care maternity (mother)

DIV M Age 8- maternity care (newborn)

DIV N Age 9- neonatology care

DIV E Age 10- pediatrics care




24 hour NRG’s

Prefix nurse unit Main bedindex Other parameter NRG

DIV C, CD Type of DRG 11- surgical care

DIV D, CD Type of DRG 12- nonsurgical care

DIV G Age 13- geriatric care

DIV L 14- care for contagious patients

SPE S1 15- care for cardio-pulmonary diseases

SPE S2 16- care for diseases of the musculoskeletal system

SPE S3 17- neurologic care

SPE S4 18- palliative care

SPE S5 19-care for chronic polypathology

SPE S6 20- psycho-geriatric care




<24 hour NRG’s

Prefix

nurse

unit

Main

bedindex

Other parameter NRG

NCP before passing OR 1- preoperative care

NCP after passing OR 2- postoperative care

OPR 3- care in recovery

DIV AR Day of birth 4- care in labor room

DIV OB Day of birth 5- care in delivery room (mother)

Admission day

A2_CODE_ADMIN=8

Age

6- care on admission for baby (birth)

Admission day

A2_CODE_ADMIN<>8

Age

7- care on admission for mother




<24 hour NRG’s

Prefix

nurse

unit

Main

bedindex

Other parameter NRG

Admission day

A2_CODE_ADMIN<>8

(not NRG 6 or 7)

8- care on admission

Last NCP of stay

A2_CODE_DESTINATE=8

9- care on day of death

Last NCP of stay

A2_CODE_DESTINATE<>8

A2_CODE_ADMIN <>8

10- care on discharge (not newborn)

Last NCP of stay

A2_CODE_DESTINATE<>8

A2_CODE_ADMIN <>8

11- care on discharge (newborn)




Calculation of Ridit Score (RSI) values for every nurse item for every score value

for the whole group of NCP’s

Selection of groups of NCP’s for each NRG

Calculation of the RIDIT value for every nurse item for the selected group of

NCP’s for each NRG

Definition of the Care Profile for each NRG based on those RIDIT values

Orange = more performed than globally (RIDIT > 0.5)

Grey = less performed than globally (RIDIT < 0.5)

NRG definition




For every NRG

Calculation of the Principal Indicator for every NCP used to define the Care Profile of the NRG.

Fix the P25, P50 and the P75 values of those Principal Indicators for each NRG (Boxplot of each

NRG).

These PXX values will be used later in the assignment of the class to each NRG for each NCP.

NRG definition – Principal Indicator and Boxplot




Formula of PI for NRG Geriatrics

PI = average [RIDIT A100 + (1-RIDIT B100) + RIDIT B200 + … + (1-RIDIT Z200)

+ RIDIT Z300 + RIDIT Z400]

NRG definition – Principal Indicator




In some cases the calculation of the Principal Indicator will not be enough to

assign a unique NRG to each NCP (see later).

In that case, calculation of a Secondary Indicator will be needed.

To calculate the Secondary Indicator a selection of items will be retained. This

selection is also based on the RIDIT value of the items but is limited to the

extremes for every NRG

The most specific items : extremely more performed than globally

The most non-specific items : extremely less performed than globally

NRG Definition – Secondary Indicator




List of NRG’s defined

For each NRG

Profile of items to calculate the Principal Indicator

Boxplot to assign a class of correspondence

Profile of items to calculate the Secondary Indicator

NRG Definition - Result




Assignment of NRG to Nurse Care Periods (NCP’s) One unique NRG for each NCP




Which of the NRG’s fits best with the nurse care of a NCP?

To know this

For each NCP in the hospital, calculation of the Principal Indicator (formula and example see

previous slides) for each NRG (distinction between 24 hour NCP / <24 hour NCP)

Based on the P25, P50, P75 values of the Principal Indicator for each NRG (as previously

described), a class of correspondence is assigned

• If PI > P75 , class =3

• If P50 < PI < P75, class = 2

• If P25 < PI < P75, class = 1

• If PI < P25, class = 0





The NRG with the highest class for the PI value is retained as the NRG of the NCP.

But what if there is more than 1 NRG with the same highest class for a NCP?

• Calculation of the Secondary Indicator for the NRG’s with the same highest class.

• Same formula as for the Principal Indicator but limited to the selected set of items for each NRG.

• The NRG with the highest value of the Secondary Indicator will be retained as the NRG for the NCP.





Result

For each NCP a NRG is assigned

NB: The NRG does not necessary correspond to the bedindex of the nurse unit of the NCP.

• For I, high correspondance

• For E, moderate correspondance

• For C and D, low correspondance

• Examples - Results





Relative Weights Results of the Delphi Study




Based on the Delphi study Relative Weights are calculated for each NRG. These

Relative Weights take into account

The time necessary to perform the items of the NRG

The competence necessary to perform the items of the NRG

The Relative Weights are calculated by the FOD/SPF and will be different

depending on the class of correspondence and the type of NCP (24 hours / < 24

hour).

In the example (see next slide) increasing by class, but this is not always the

case.

Relative Weights




Relative Weights – Example (FOD/SPF)




A Relative Weight will be calculated per patient per observation day.

If there is more than 1 NCP for an observation day (and also more than 1 NRG)

the relative weigths are summed for that day.

Relative Weigths




A relative weight per patient per observation day

Relative Weigths - Result




Market share Impact on financing




Which hospital needs more resources because the nurse activity is higher, more

intensive, …. than ‘on average’?

Per bed index (at this moment limited to bed index C, D, E, I)

The median of the relative weights per observation day is calculated (over all hospitals).

For each hospital for each observation day, the difference between the relative weight and

the median is calculated.

• If negative difference (relative weight < median), ignore

• If positive difference (relative weight > median), retain for further calculations

Market share




Bed index CD

Median

RW per patient per observation day

Observation days




Sum all positive differences (Relative weight – Median) on hospital level (Hospital Positive

Difference)

Sum all positive differences of all hospitals (Total Positive Difference)

Calculate the Market Share of each hospital

• Market Share = Hospital Positive Difference / Total Positive Difference

Based on this Market Share of the hospital, resources will be allocated to each hospital as a

share of the budget to be allocated.

Application (transition from ‘old’ system to ‘new’ system) will be spread over several (3?)

years.

Market Share




Thank you

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