|Target version:||Expert Group 2015|
|Case type:||Major||Owner / responsible:|
|MDC:||Old forum status:|
Revision of DRGs regarding Multiple significant trauma (484, 485, 486, 486O and 487) – HDG 21
Initiator: Norwegian traumatologists at Oslo University Hospital
Norwegian Directorate of Health, Fredrik A.S.R. Hanssen and Kristin Dahlen
This case is related to Case #179 from Finland
Traumatologists at Oslo University Hospital (OUS) have looked into the DRG logic of DRGs 484, 485, 486O and 487 and suggests a revision of which ICD-10 codes should be cathegorized as “significant” or “not significant” according to the multiple significant trauma. With reference to the earlier discussed revision on mulitiple trauma suggested by the Fins (Case #179), Norway suggests a revision based on the input from the Trauma Registry at Oslo University Hospital (OUS). The revision will not affect the present DRG structure.
The suggestion from OUS is based on an opinion that the present DRGs give a good description of the field. However, the traumatologists state that it is necessary to do a revision of the diagnosis properties in order to make the system more consistent. Some codes describing serious injuries are not classified as “significant” in todays DRG-logic, while other codes classified as “significant” should not be. The suggestion is based on The Abbreviated Injury Scale (AIS), and the traumatologists own experience with severely injured patients.
All changes to to the propeties are lised in table Multitraume_spesifisering logikk endring.xlsx. The picture are clibs from that table.
1) Columna injuries
The presented codes marked with “IN” and “Columna” (link regneark) shall be classified as “significant”. Fractures and dislocations in columna are serious injuries that must be included in the diagnostic groups that control multi trauma.
Codes presented in (link regneark) and marked with “OUT” and “Columna” shall not be classified as “significant”. The injuries on smaller nerves presented here are considered as injuries of less severity.
2)Injuries on large blood vessels
The presented codes marked with “IN” and “blood vessel” shall be classified as “significant”. Injuries in the mentioned anatomical structures are very serious for the patient, and must be included in the groups of significant trauma.
Codes presented in and marked with “OUT” and “blood vessel” shall not be classified as “significant”. The ICD-10 codes presented here represents superficial vein injuries which shall not group to DRGs for multiple significant trauma.
Open wounds without injury in underlying organs, is normally not considered as a serious injury. Multiple open wounds do not necessarily increase the severity, and we therefore suggest that codes presented in and marked with “OUT” and “”open wounds” should not be classified as “significant”.
4)Nerve damage in arms and legs
We observe some inconsistency in the DRG logic for these injuries. We suggest that all damages in arms and legs shall be considered as multi trauma. Nerve damages in foot shall loosen their “significant” property, marked “OUT” and “nerve damage arms and legs”.
Codes representing injuries with high severity should have properties classifying them as “significant”. Following codes are lacking in the present logic, (link regneark) marked with “IN” and “other diagnosis”.
We suggest that codes presented as “OUT” and “other diagnosis” in, according to their presumptive low severity, shall not have “significant” property.
#1 Updated by Martti Virtanen over 4 years ago
2015-003-07 Martti Virtanen
This proposal deals with the same matter as the Finnish proposal in Case #179. The Finnish proposal is based on thorough economic and clincal analysis of the problems in the multiple trauma grouping.
The Norwegian analysis is lacking economic analysis of the effects of the change of the grouping. To make any decission about such a major change it is necessary to do the economic analysis.
Further analysis is necessary and since the proposal was sent quite late (16.2 2015) we will not be able to get these analysis done for the expert meeting. Because of the major disgreement between Finland and Norway, it is obvious that a working group and some physical meetings will be necessary.
#8 Updated by Kristiina Kahur over 4 years ago
2015-03-09 Kristiina Kahur
The work Norway has done with Multiple significant trauma DRG logic is no doubt significant and is more than appreciated.
Nevertheless, the revision has been done only from clinical point of view and the cost data and analysis is lacking. Therefore there is no evidence whether or not the logic would work form costs point of view.
As Martti mentioned, for cost-analysis more time is needed and therefore it is difficult to give any comment on that proposal in current moment.
#11 Updated by Anonymous over 4 years ago
- File Annex3-KristiinaKahur´s-presentation.pdf added
- File Annex4-NilsOddvarSkaga´s-presentation.pdf added
I have added the presentations, which were presented on 12th of March in Expert Group Meeting. (These presentations are included also with the minutes of the meeting, send via e-mail to all attendees.)
#13 Updated by Martti Virtanen over 3 years ago
- Status changed from Active to Further active
2016-03-15 Expert group (MV)
There is interest to the multiple trauma problem in Sweden and Norway. The Finnish model seems not to work in the other countries.
Norway made a proposal which was supposed to be based on the original model. Instead the Norwegian changes applied on the Finish model. The testing needs to be repeated.
Norway will resend the tables for the proposal.
#14 Updated by Kristin Dahlen almost 3 years ago
Norwegian directorate of Health - Kristin Dahlen
We do not support any change of the multiple trauma logic at the moment.
We will await Norwegian cost per patient data, and we hopefully can do some analysis on the Finnish model and our cost data during 2017.