Case #370

Gender Validation

Added by Anonymous over 4 years ago. Updated 10 months ago.

Status:AcceptedStart date:2016-12-21
Priority:MajorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
Case type: Owner / responsible:National organisations
MDC:MDC13 Old forum status:
Target Grouper:SWE

Description

National ID: C376
Initiated: 2012-01-02
Initiator: Ralph Dahlgren, Mats Fernström
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Problem
From the NordDRG users there are comments that there are incompatibilities with certain DRGs and gender.
For example, now a male, with a (male) personal number can have all the female internal genitalia remaining. Likewise, there are many women who choose to live their lives with testicles and penis.
The wishes are that NordDRG is updated to the reality we live in.
Analysis
The Swedish National Board of Health and Welfare 2014-12-10
No economic analysis is needed. This is more an ethical discussion because the patients involved feel exposed to prejudices and they are increasing in numbers. The NordDRG system should not support such prejudice, this according to Swedish guidelines and laws. As far as we know Finland also has a similar discussion. It was mentioned at the meeting in Reykjavik 28-29 August 2014 and it was suggested that Sweden made a case about this.

Suggestion
The Swedish National Board of Health and Welfare 2014-12-10.
The suggestion is that the PreMDC (validation) rules for gender leading to DRG 470 (Z72 in SWE) are removed and that the demand F or M in the field SEX in all other rules is removed.

The suggestion is to be implemented in NordDRG 2016 at least for Sweden.

In Sweden The National Board will instead publish a list of gender related diagnoses codes so that the care providers can implement a “softer” gender validation in their patient administrative systems like a pop-up window that can be clicked away with a text similar to “The diagnosis and gender combination is unusual. Are you sure?”

Technical change
DRG Z72O-N and Z73O-N will be inactivated (automatically) in the Drgnames table.
In the DRGlogic table the preMDC rules for DRG 470/Z72O-N (Ord 000-014) with values "F", "M" or "-" in column "Sex" will be deactivated.
All other occurrencies of “F” and “M” in column "Sex" will be be replaced by empty.
Effectively the column "Sex" gets inactivated in NordDRG!
For more details, see Excel file “Appendix C376”.

DRG change
Minor. There will be a few cases that will go from a Z DRG (470) to former gender specific DRGs. The gender specific DRG's will no more be gender specific.

Appendix C370 updated.xlsx (64 KB) Anonymous, 2015-02-26 14:35

Case #370 Technical changes.xlsx (64.3 KB) Martti Virtanen, 2015-03-25 19:08

370MATS.jpg (43.4 KB) Anonymous, 2015-10-26 13:40

Decision #370_C376 SWE 2017.xlsx (15.6 KB) Mats Fernström, 2016-02-17 08:54


Subtasks

Case #496: Reintroduction of DRG Z73 ‘Patient’s gender is missing’AcceptedMats Fernström

History

#1 Updated by Anonymous over 4 years ago

  • File C340 to Forum.docx added
  • Target version set to Major-proposals-for-2016

#2 Updated by Anonymous over 4 years ago

  • File deleted (C340 Appendix.xlsx)

#3 Updated by Anonymous over 4 years ago

  • File deleted (C340 to Forum.docx)

#4 Updated by Anonymous over 4 years ago

  • File C376 Appendix.xlsx added

#5 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

2015-02-17 Martti Virtanen
I have modified the basic proposal to adjust for all versions.
The rules with Sex '-' need also to be inactivated. This makes the column sex obsolete in the NordDRG system.

#6 Updated by Anonymous over 4 years ago

Mats Fernström, NPK, Sweden 2015-02-25
Marttis comment is (as usual) correct. The rules with minus sign in the column “sex” must also be deleted. An updated version of Appendix C376.xlsx is included.

#7 Updated by Anonymous over 4 years ago

  • File deleted (C376 Appendix.xlsx)

#8 Updated by Martti Virtanen over 4 years ago

2015-03-13 Expert group/MV
The expert group accepted the change for all versions.
The column sex unnecessary.
The technical changes document is incomplete, since it is based only on NordDRG SWE. It is essential that in all versions the column will be empty as described in Technical changes above.

#9 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#10 Updated by Martti Virtanen about 4 years ago

2015-08-11 Martti Virtanen
The rules 123D032030 for DRG 912O 'Disease or disorder of the male reproductive system, short therapy w/o significant procedure' and rule 123D032031 for DRG 913O 'Disease or disorder of the female reproductive system, short therapy w/o significant procedure' become identical after the changes in this case. Therefore all cases are assigned to DRG 912O (for males). This is obviously not correct.
Since even in these cases the registered gender is not to the nature of the disease, the grouping accordign to gender is not acceptable. There is no group for these unspecified cases without specified gender. Therfore we will inactivate both rule 123D032030 and 123D032031. The very few cases will be assigned to DRG 923O 'Factors influencing health status and other contacts with health services, short therapy w/o significant procedure'.
The same problem exists for rule 423D0633 for DRG 352X/N59N 'Other male reproductive system diagnoses' and rule 423D0634 for DRG 369N/O50E'Menstrual & other female reproductive system disorders'. These rules must also be removed. The similarly very few cases will be assigned to DRG 467X/W29A-C-E 'Other factors influencing health status' (in Swe version with differen CC-levels)

#11 Updated by Anonymous almost 4 years ago

2015-10-21 Mats Fernström, NPK, Sweden
DRG 912O and 913O don’t exist in the Swedish version but we have the same problem with all six rules with DGCAT 23M04 and PGPROP 98X99. See the table below. Rules marked with the same color are identical.

We have studied the possibility to create new DRGs in MDC 23 for “problems in the reproductive system, unspecified gender” but the numbers of contacts allocated according to these rules are too small. In the Swedish Patient Register for 2013 there were no visits grouped according to the rules with ORD 200D1382 & 200D1782 and only 354 visits grouped according to the rules with ORD 200D1392 & 200D1792 and only one admission grouped according the rules with ORD 423D0633 & 423D0634.
The present situation is not acceptable so we support Marttis idea to delete these rules. This must be regarded as an error to be corrected in the final version for 2016 without prior discussion on an expert meeting.

#12 Updated by Martti Virtanen over 3 years ago

2016-01-18 Martti Virtanen
Norway has proposed that the rule 191D13090 of NordDRG Nor version to be removed. This is one of the rules where gender has affected grouping. The current rule without sex=F results in male to be grouped to this DRG which is obviously not correct.
The cases will be assigned to DRG 923O 'Outpatient contact with healthcare'
The change will be valid in NordDRG Nor 2016 and has no effect on other versions of NordDRG

#13 Updated by Anonymous over 3 years ago

  • Target version changed from Major-proposals-for-2016 to Expert Group 2015

#14 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden 2016-02-17
Associated with this case, Sweden has decided to make some DRG text changes in version 2017 that are presented here just for information.
It is no longer sure that male individuals (according to the legal gender) always have male genital organs and vice versa and since the grouping logic of cases with DGCAT 98Mxx is based on the legal gender, not the biological gender, we have decided to change the texts for the DRGs where DGCAT 98Mxx is involved in any of the rules. The principles for the text changes are that “manliga genitalia/könsorgan” (male reproductive system) is exchanged to “genitalia hos man” (reproductive system in male) and “kvinnliga genitalia/könsorgan” is exchanged to “genitalia hos kvinna” (reproductive system in female). The text changes are specified in the file Decision #370_C376 SWE 2017.xlsx.

#15 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Further active

2016-03-15 Expert group (MV)
The exerpt group accepted the additional changes for this case.
The Swedish list of DRG's where the conversion group 98Mxx diagnositic categories to 12Mxx or 13Mxx may affect the grouping is, however incomplete. For example Additionally I am afraid that the change of wording is not satisfactory.
For example 335N/N01N 'Major male pelvic procedure' is affected as are DRG's 354x-355x/O02x, 357x/O10x etc. The former is mainly a problem of wording whereas the the others are a more complex problem where the cases will not be assigned to correct DRG's at all.

Maybe we should consider combining MDC 12 and MDC 13 to one group where specific interventions and diagnoses would be associated with specific DRG's and unspecific with common DRG's not depending on gender. The change is substantial but it is the only true say out of the gender specified rules.

The issue needs further consideration and therefore the case is not closed.

#16 Updated by Anonymous about 3 years ago

  • Status changed from Further active to Accepted

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