Case #1

Development initiative #74: Development of grouping MDC15 - Newborn

Case 2013-MDC15-02 - Normal Newborns in DRG 390 'Neonate, birthweight 2500 g or more, with other significant problem'

Added by Redmine Admin over 7 years ago. Updated almost 7 years ago.

Status:AcceptedStart date:2013-01-27
Priority:MajorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Expert Group 2013
Initiator:Finland Target year:2014
MDC:MDC15 Owner / responsible:National organisations
Target Grouper: Old forum status:

Description

Initiated: 2011
Initiator: Helsinki University Hospital

Expert Network 2013-03-12: No change recommended
Board 2013-03-27: No Change


Problem

Finnish national DRG-center got a proposal from Helsinki University Hospital and also from Central Finland Central Hospital that MDC 15 should be analyzed and tested. The working group went through the DRGs in MDC15 and came up with two proposals for change to the grouping logic in some DRGs.

It seems that not all cases assigned to DRG 390 have any significant clinical problem. The resource analysis proved that cases without any other registered problem indeed proved to be less resource demanding.

Analysis

For analysis the cases of year 2011 grouped to MDC 15 were used. The data set was combined with cases from five Finnish university hospitals as well as from central hospitals. For grouping Finnish 2011 Full version was used.

Suggestion

We suggest that some P and Q chapter diagnosis should loose the diagnosis property 15X98 (Other significant problem of neonate, currently 7764 Dx in the Finnish version) and be removed from diagnosis category 15M99 (neonatal residual category) to 15M02 (Normal newborn, currently 28 Dx in the Finnish version).

The selection of diagnoses is based on the clinical opinion that these diagnoses do not indicate any need for additional intervention and neonates without any other significant dx should be regarded as normal newborns.

With this change the cases without any other significant dx currently assigned to DGR 390 will be assigned to DRG 391.

The analysis of resource use by cost in DRGs 390 and 391 before and after the proposed changes shows the follows:

COMMENTS:

Swedish comment 2013-03-09

With this suggestion, the coefficient of variation (V%) will increase both in DRG 390 and in DRG 391. The increase in DRG 391 is substantial (from 86% to 131%!). An increase of V% in DRG 391 (=Q60N) was found also in Swedish data.

Furthermore, from the Finnish data we have calculated that the mean cost of the 124 cases that are transferred from DRG 390 to DRG 391 is 3 321 €, which is more close to the mean cost in DRG 390 than to the mean cost in DRG 391.

It is obvious that the clinical judgment in this case does not correspond to cost data and we do not support the suggestion as it is. We think that the material has to be economy analyzed further. One should calculate the mean cost per principal diagnosis, both in DRG 390 and in DRG 391, and after that assess what diagnoses should be included in these two groups.

Expert group 2013-03-12

As presented by Sweden the Expert group noted that the change would not result in an improvement of the grouping.

The mean effect on cost of each diagnosis on the list needs to be analyzed to be able to estimate which of the diagnosis belong to the diagnosis that should change properties. It should cover both primary and secondary diagnosis because of the special nature of the neonatal work.

The analysis needs to be done first in Finland and to be confirmed at least with Swedish data.

Comment Finnish National DRG Centre Kristiina Kahur / Minna-Liisa Sjöblom 2014-02-18:

After having reviewed and analysed these cases we decided not to go on with further analysis and suggest closing both cases.

table4.jpg (44.2 KB) Anonymous, 2013-08-29 07:48

table3.jpg (386 KB) Anonymous, 2013-08-29 07:48

History

#1 Updated by Anonymous over 7 years ago

  • Tracker changed from 1 to Case

#2 Updated by Anonymous over 7 years ago

  • File table4.jpg added
  • File table3.jpg added
  • Subject changed from Case 2013-GEN-01 ECLA/ECHLA (/ECMO) indicates high level intensive care to Case 2013-MDC15-02 - Normal Newborns in DRG 390 'Neonate, birthweight 2500 g or more, with other significant problem'
  • Description updated (diff)
  • Target version set to 5
  • Old forum status set to FURTHER ACTITEM - Further active item
  • MDC MDC15 added

#3 Updated by Anonymous over 7 years ago

  • Target version changed from 5 to Expert Group 2013
  • Case type set to Major

#4 Updated by Anonymous over 7 years ago

  • Status changed from Active to Further active

#5 Updated by Anonymous about 7 years ago

  • Parent task set to #74

#6 Updated by Martti Virtanen about 7 years ago

  • Status changed from Further active to Active
  • Case type changed from Major to Further active
  • Initiator Finland added

#7 Updated by Anonymous about 7 years ago

  • Priority changed from Normal to 23
  • Target version changed from Expert Group 2013 to Expert Group 2014
  • Start date changed from 2013-07-23 to 2013-01-27
  • Owner / responsible National organisations added
  • Target year 2015 added

#8 Updated by Anonymous about 7 years ago

  • Description updated (diff)
  • Assignee set to Kristiina Kahur

#9 Updated by Anonymous about 7 years ago

  • Description updated (diff)
  • Status changed from Active to Accepted
  • Priority changed from 23 to Major
  • Target version changed from Expert Group 2014 to Expert Group 2013
  • Old forum status deleted (FURTHER ACTITEM - Further active item)
  • Target year 2014 added

#10 Updated by Anonymous almost 7 years ago

  • Case type deleted (Further active)

Also available in: Atom PDF