Case 2005-MDC15-04 P22 Respiratory distress of newborn
|Target version:||Expert Group 2010|
|Initiator:||Norway, Sweden||Target year:||2011|
|MDC:||MDC15||Owner / responsible:|
|Target Grouper:||COMMON||Old forum status:||CLOSITEM - Closed item|
Last updated: 2010-04-09
Status: CLOSITEM - Closed item
Initiated - 2004-05-03, 2010-02-19
By: Pär Ansved/Mats Fernström, CPK/Sweden
Kristin Dahlen, Helsedirektoratet, Norway
Expert Network 2005-04-08 - Postpone recommended
Steering Group 2005-04-19 - Recommendation accepted
Expert Network 2006-03-22 - Postpone recommended
Steering Group 2006-04-19 - Recommendation accepted
Expert Network 2007-03-28 - Postpone recommended
Steering Group 2007-04-11 - Recommendation accepted
Expert Network 2008-03-06 - Change recommended
Steering Group 2008-03-31 - Recommendation accepted
Expert Network 2010-03-13 - Change recommended
Board 2010-04-09 - Recommendation accepted
CPK ID 180
The severe P220 (Respiratory distress syndrome of newborn) should not be grouped to the same DRG as the less severe P228 (Other respiratory distress of newborn), i.e. DRG 390 (Neonate, birthweight 2500 g or more, with other significant problem).
The question has been translated and shortened by Mats Fernström at CPK.
Mats Fernström, CPK 2005-03-03
It seems to be true that patients with the primary diagnosis P220 are much more expensive than patients with other primary diagnoses beginning with P22. See Swedish cost data for 2003 in table 1.
The grouping logic in MDC 15 is rather complicated, however, and even though P220 and P228 are grouped to DRG 390 when registered alone, most cases with P220 are in reality allocated to other DRGs. A majority of the cases with P228 (158/207 or 76%) is allocated to DRG 390 (table 2) but only a small portion of the cases with P220 (4/60 or 7%) is allocated to DRG 390 (table 3).
The expensive P220 cases are not very frequent in DRG 390 but there seems to be a problem in DRG 388B. Is it enough to necessitate a change in the DRG logic? If so, I have no suggestion how to do the change.
Expert Network 2005-04-08
The meeting recommended postponing the case. The Nordic Centre (Martti Virtanen) should investigate it further.
Expert Network 2006-03-22
An analysis presented during the meeting, using Finnish data (P220 problem.xls) indicated that the original problem of P22.0 in DRG 390 may not really be problem since there were no such cases. This supports the result from Swedish data last year. P22.0 is much less frequent in Finnish data than in Swedish data (21 cases in Helsinki vs. 305 cases in Sweden). Further analyses on grouping rules for neonates with multiple problems or other problems are necessary.
The meeting recommended postponing the case, pending further analysis from the Nordic Centre.
Expert Network 2007-03-28
The meeting recommended postponing the case again, pending further analysis from the Nordic Centre.
Martti Virtanen 2008-02-26
The analysis of effect of dx P22.0 on cost of neonatal inpatient care.
The following table is based on Finnish 2006 data. It includes all classical cases from MDC 15. All groups have divided to those with P22.0 (as principal or secondary dx) and those without.
Severe respiratory problem of newborn
It is obvious that in almost all groups P22.0 has a significant effect on cost. This effect is more marked in the more mature infants (DRG 389B and DRG 390) which have actually a higher cost than somewhat less mature infants (DRG 387N, DRG 388A and DRG 388B). Very immature infants (DRG 386N) have no effect of P22.0 possibly because their treatments is any way very expensive. Larger infants with major surgery (389A) have a much higher level of cost and cannot be combined to the other groups. The total effect on variance is scarce and a separate group would be too small. Patients with early death or remission (DRG 385A) and aftercare (DRG 385B) have a much lower level of cost. Also in these groups the effect on variance would be minor and the new groups would be too small. Normal newborn (DRG 391) should basically not have dx P22.0. The one case must be result of false coding.
Adding two new DRG’s 388C ‘Severe respiratory problem of premature infant’ and 389C ‘Severe respiratory problem of mature infant’ will clearly increase the homogeneity of the the MDC. The new groups will have enough cases (the data is round 25% of Finnish population) and even all old groups remain on acceptable level.
Expert Network 2008-03-06
The meeting accept the proposal to create two news DRG’s 388C ‘Severe respiratory problem of premature infant’ and 389C ‘Severe respiratory problem of mature infant’
Two new DRG’s are created
- 388C ‘Severe respiratory problem of premature infant’
- 389C ‘Severe respiratory problem of mature infant’
A new diagnosis property is created:
- 15X40 ‘Severe respiratory problem of newborn’
P22.0 is assigned the new property 15X40.Four new rules are added before current rule 015D8130. First two are copies of the rule 015D8130 and the other two of 015D8131. In all four rules the DRG is changed to 388C.
- In the first copy of 015D8130 the Dgprop2 is changed to 15X40.
- In the second copy Dgprop1 is changed to 15X25 and Dgprop2 to 15X40.
- In the first copy of 015D8131 the Dgprop2 is changed to 15X40.
- In the second copy Dgprop1 is changed to 15X25 and Dgprop2 to 15X40.
Secproc1 or all four rules is given value -15S01.
Note that 015D8130 and 015D8131 are inactive in the Nordic common version because the corresponding dx to diagnosis property 15X24 does not exist. The first copies do neither appear in the common versions for the same reason.
Two new rules are placed before current rule 015D81900. The first is a copy of current rule 015D81900 and the second of 015D81901. DRG is changed in both rules to 389C. Dgprop1 is changed in both rules to 15X40 and Dgrprop2 is cleared also in both rules.
A new rule is place after current rule 015D80002. It is a copy of current rule 015D80002. Procpro1 is cleared and Dgrprop1 is given value 15X40. (DRG will be 470 according to Case 2008-GEN-04 [[http://documents.norddrg.net/issues/189]]).
Cases with P22.0 are assigned to DRG 388C / 389C depending on the degree of prematurity. Cases claimed to be normal newborns (dx category 15M02) with P22.0 are falsely coded and are assigned to DRG 470.
Case with major surgery are assigned to DRG 389A as before.
Kristin Dahlen, Norway, 2010-02-19
Respiratorisk distress syndrom (ref Case 2005-MDC15-04 implemented i 2009).
As a result of the case 2005-MDC15-04, all neonates with respiratory distress syndrome (P22.0) but the ones with extreme low birth weight (<1000g), are grouped to one single DRG, DRG 388C.
In our material from 2009, ALOS for neonates in DRG 388C is 30 days. In DRG 387N it is 40 days. This indicates that treating of low birth weight is more resource intensive than treating of respiratory distress syndrome. In 2009, we have approximately 500 neonates in 388 C and 150 neonates in 387N.
We suggest that the former change is partially revised so that low birth weight is a primary grouping criteria even if the neonate also has respiratory distress syndrome.
As a result of the change all neonates with birth weight 1000-1500 gram are grouped to DRG 387N, and only heavier babies with P22.0 are grouped to 388C.
Expert Network 2010-03-12
The meeting recommended to move DRG 388C after 387N. Current data indicates that the number of affected cases is very small, much smaller than in the analysis from Finnish 2006 data.
The rules for DRG 387N ORD 015D8130 and ORD 015D8131 are moved before the rules for DRG 388C (to position 015D8110 and 015D8111.
Rules for ORD 015D8120 and 015D8122 shall be removed.
Cases with birth weight below 1500 g are not assigned based on RDS.