Case #107

Case 2013-MDC14-05 Vacuum/forceps/breech delivery, multiple deliveries, and preterm delivery

Added by Anonymous almost 6 years ago. Updated about 3 years ago.

Status:AcceptedStart date:2013-10-25
Priority:Error correctionSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2013
Initiator:Finland Target year:2014
Case type:Major Owner / responsible:National organisations
MDC:MDC14 Old forum status:CLOSITEM - Closed item
Target Grouper:FIN

Description

Last updated: 2013-03-27

Status: CLOSITEM - Closed item

Initiated:2011

Initiator: Helsinki University Hospital

Responsible at NPK: Kristiina Kahur, Minna-Liisa Sjöblom

Sent to NordDRG Forum (date): 27.1.2013

Expert Network 2013-03-12 No change recommended

Board 2013-03-27 No change in common version of NordDRG

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Problem

Finnish national DRG-center got several proposals from Helsinki University Hospital with respect that DRGs in MDC 14 should be revised and analyzed. The main problem was related to DRG 373 also other groups were considered problematic.

During several meetings a working-group of clinical and economical experts was revised all DRGs in MDC 14 and came up with 6 proposals.

Analysis

The analysis was performed on cases in MDC 14 in a combined data from year 2011 in all five Finnish university hospitals. For grouping Finnish 2011 Full version was used, in case of DRG 379 CC-grouper was used.

Suggestions:

Assigning complicated deliveries to DRG 372

Based on the cost of vacuum/forceps/breech delivery, multiple deliveries, and preterm delivery we suggest these cases should be removed from DRG 373 Vaginal delivery w/o complicating diagnoses and assigned to DRG 372 Vaginal delivery w complicating diagnoses. The cost analysis shows that the above mentioned cases in terms of costs are more close to ones of DRG 372 rather than 373.

Comments

Swedish comment 2013-03-07

In Sweden DRG 372 & 373 have been replaced by the following groups:

  • P05A Vaginal förlossning, mycket komplicerat
  • P05C Vaginal förlossning, komplicerat
  • P05E Vaginal förlossning, ej komplicerat

According to Swedish cost data, cases with Breech/Vacuum /Forceps/Preterm/Multiple deliveries within DRG P05E suits very well there and we do not want any change.

Expert group – 2013-03-12

Based on the Swedish figures the expert group did not recommend any change to the grouping.

Martti Virtanen – 2013-03-18

There is an error in the Swedish analysis. The trimmed analysis is based on cases trimmed accordign to the original grouping. Out of the 527 cases trimmed 234 are trimmed from the special groups. However, even the untrimmed mean of the largerst group (Bf/Va/Fo) indicates that the proposed change is not an improvement in the grouping.

Martti Virtanen 2013-04-30

Finland has decided to implement the proposed change in NordDRG 2014 FIN. The description of changes is valid only for the Finish version.

DECIDED CHANGES

DRG Change

Cases with forceps delivery (O8100, O8110, O8120 and O8130) and vacuum delivery (O8140 and O8150), with breach delivery (O8300 and O8310) and with multiple delivery (O8400, O8410, O8480 and O8490) will be assigned to DRG 372.

Dx O8420 'Multiple delivery, all by caesarean section' is not included because ceasarean section has other assignment rules.

Technical change

A new diagnosis property 14X13 'Forceps and vacuum delivery and breach and multiple delivery'

The dx's listed above (O8100, O8110, O8120, O8130, O8140 and O8150, O8300, O8310, O8400, O8410, O8480 and O8490) will be given this new property. The property shall be given in the common version and all national versions will have the new property available but inactive.

In the Finnish NordDRG logic two new lines will be added immediately after current line 400D71311. They will be copies of current lines 400D71310 and 400D71311. Dgprop2 is changed on both lines from 14X11 to 14X13.

Introduction

NordDRG 2014 FIN

MDC14-05_2.png (30.1 KB) Anonymous, 2013-10-25 13:35

MDC14-05_1.png (30.4 KB) Anonymous, 2013-10-25 13:35

History

#1 Updated by Martti Virtanen almost 5 years ago

  • Status changed from Rejected to Re-activated

2014-09-24 Martti Virtanen
A Finish obstetrician has noted that breech delivery is not assigned to DRG 370 'Complicatied delivery' as it was planned. The reason is that O80.1 'Spontaneous breech delivery' is not included among the dx that have property 14X13 'Obstetrical problem'. The finnish obstgetricians say that the an obstetrician (MD) is always present during the delivery in these cases. In these cases they seem to register in most cases the intervention MASG00 (MAG00) 'Assisted breech delivery'. In more complex cases the intervention MASG10 'Breech extraction delivery'. These interventions have exactly same cost for example in Helsinkin University Hospital system.

This is a case of small error that needs to corrected.

Technical change: O8010 (ICD+ code) and all linked national codes is given property 14X13.

DRG change: In NordDRG FIN all cases with breech delivery will be assigned to DRG 370.

Version: NordDRG FIN 2015 - no other version uses dgprop 14X13.

#2 Updated by Kristiina Kahur almost 5 years ago

2014-09-25 Kristiina Kahur

OK

#3 Updated by Anonymous over 4 years ago

  • Priority changed from Normal to Error correction

#4 Updated by Anonymous over 4 years ago

  • Status changed from Re-activated to Further active

#5 Updated by Anonymous about 3 years ago

  • Status changed from Further active to Accepted

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