Questions and answers #508
Intensive care in the NordDRG grouping logic
|Status:||Closed ticket||Start date:||2017-01-17|
|Target version:||Expert Group 2017|
|Case type:||Owner / responsible:|
|MDC:||GEN||Old forum status:|
This is nor the suggestion for any changes neither the development initiative. It is rather a discussion topic for Expertnetwork meeting. It concerns intensive care (IC) and other demanding care and its impact on grouping logic in NordDRG system.
From resource point of view IC is much more demanding, no doubt. Nevertheless, it is not explicitly taken into account in the NordDRG grouping logic (at least not in Common version).
In NCSP there are some codes referring to IC, e.g.
• WAA880 Intensive care
• WAA890 Intensive care monitoring
• WAA899 Other intensive care monitoring
There are also some codes for mechanical ventilation (PROPPROC 04S03) which leads to DRGs 475A Respiratory system diagnosis with respirator therapy, 475B Respiratory system diagnosis with PEEP support or 475O Respiratory system diagnosis with ventilator support, short therapy.
In Finland the use of abovementioned codes on national level is uneven, at least the data submitted to National DRG-centre show that. However, the problem can be in data transfer within the hospitals’ information management system rather than in coding which means that data exist but has not made available and/or transferred.
There is evidence from some other casemix systems (e.g. Australia, Germany.) where intensive care has been taken into account in grouping logic by using e.g. the information of duration of artificial ventilation, time in intensive care unit, tracheostomy. The latter is also used in NordDRG system but some countries have met some problems with this since it is not (anymore) in line with main principles of case-based system by what the groups should be clinically meaningful and economically homogenous.
E.g. Estonia is no longer using in their national version DRG 483, Tracheostomy except for face, mouth & neck diagnoses. In Nordic Casemix Conference representative of Norway Dag Refvem presented in his presentation the challenges they meet with how to better describe the severity of illness, and how for instance DRGs 475A/B or 483 do not serve that purpose. Also Prof Hans Flaatten referred in his keynote to similar issues in the NCC and PCSI conference.
Should it be Sofa or TISS score, should the NCSP codes related to IC given the CC-property, or anything else, the accurate and unified coding comes first and grouper updates only after that.
Nevertheless, we would be glad to discuss it during the meeting and listen to other countries’ thoughts whether it is worth to give it a try and analyze whether or not it makes sense to take into account the clinical severity and resources of IC or other demanding care in NordDRG grouping logic.