Case #567

MDC-specific DRG-groups for nurse visits

Added by Veronika Stemme about 2 years ago. Updated about 1 year ago.

Status:AcceptedStart date:2017-12-21
Priority:NormalSpent time:-
Assignee:Veronika Stemme
Category:-
Target version:Target version 2019
Initiator:Sweden Target year:2019
Case type:Major Owner / responsible:National organisations
MDC:GEN Old forum status:
Target Grouper:SWE

Description

Problem
National Board of Health and Welfare, Sweden – 2017-12-21
Nurses have independent patient visits in many different health care areas. These independent nurse visits are increasing and there is a need for a better medical description of them. We suggest the creation of new nurse visit-DRG-groups, one per MDC, to enhance the medical description of these visits.

Analysis
This a matter of medical description, no economical analysis is needed.

Suggestion
We suggest the creation of 24 new nurse visit-DRG-groups, one per MDC.

Decided changes
Sweden wants this change to be implemented in the Swedish NordDRG 2019.

DRG change
Nurse-visits with a registered ICD-10-diagnosis code were before assigned to DRG Y83O ‘Övriga sjuksköterskebesök’/ 970V ‘Other nurse visits’. They will now instead go to the new MDC-specific DRG-groups for nurse visits.

Technical change
24 new MDC-specific DRG-groups for nurse visits are introduced with 49 new rows in DRG-logic.
We suggest that these new DRG-groups should be put between
ord
200D208000 J80O/826W Medicinsk badbehandling och smörjning, besök
and
200D211000 Y75O/951V Övriga psykologbesök
in the hierarchy of DRG-logic.

See file “Technical_changes_CPK-ID 662.xlsx”

Technical_changes_CPK-ID 662.xlsx (23.1 KB) Veronika Stemme, 2017-12-21 13:44

Technical changes case #567.xlsx (87 KB) Martti Virtanen, 2018-02-27 13:19

Cost per MDC in DRG Y83O.xlsx (11.3 KB) Veronika Stemme, 2018-03-07 13:54

History

#1 Updated by Martti Virtanen about 2 years ago

2018-02-27 Martti Virtanen
This proposal has a few things that may need to be considered and 2 obvious errors.

1) The most obvious question is that the grouping to these new DRG's demands a diagnosis to be registered on a nurse contact. There have especially in Sweden problems of nurses using diagnosis coding. Is that solved?

2) Cases with procprop 05V11 'ECG' (orange colour) and 07V01 'Extracorporeal shock wave litotripsy' (green colour) are assigned by existing preceeding rules to other DRG's. The new rules will never work without some changes.

3) Obstetric nurse treated cases will be assigned by the new rules to a new DRG. However, if the nurse is a mid-wife, such a contact will be assigned to Mid-wife contact that is anothe DRG (light red colour) . I think mid-wifes are nurses, so this may divide the cases to two DRG's.

4) Contacts for pain problems (blue colour) can be assigned to contacts with medical doctor, with nurse, with a team and with medical doctor by phone in this order. If team includes a nurse, should the contact be assigned to nurse contact group? In general the same question is valid for doctors also.

5) Team contacts in general (light blue colour) all placed after the nurse contacts (and medical doctor contacts). Is it intended that the individual professionals are also registered when a team is involed.

The attached technical changes file includes the unchanged parts of proc and procprop tables that influence the groupin. The logic table includes a large number of related rules that show a more broade picture of the changes. Using the column 'mark' or the colours one can see diffent aspects of the grouping.

The question that arise are obviously at least partly related to resource use of the different cases. Maybe some economical analysis might still be usefull.

#2 Updated by Veronika Stemme almost 2 years ago

Veronika Stemme, NPK, Sweden.
For clarity reasons I reprint Marttis questions with our answers after each question.
1) The most obvious question is that the grouping to these new DRG's demands a diagnosis to be registered on a nurse contact. There have especially in Sweden problems of nurses using diagnosis coding. Is that solved?
If no diagnosis-code is registered the nurse visit will be directed to an already existing general DRG for nurse visits. The diagnosis registration differs a lot between the different regions in Sweden, in some regions it is quite high but lower in others. We hope that the creation of the new, more informative, DRG-groups will stimulate an increased diagnosis coding by nurses.

2) Cases with procprop 05V11 'ECG' (orange colour) and 07V01 'Extracorpo-real shock wave litotripsy' (green colour) are assigned by existing preceeding rules to other DRG's. The new rules will never work without some changes.
There are rows like this for doctor-visits (now lacking the procpro 99V35 ‘Medical doctor’, but that will be corrected, see #578). Corresponding rows for nurses should work as well.

3) Obstetric nurse treated cases will be assigned by the new rules to a new DRG. However, if the nurse is a mid-wife, such a contact will be assigned to Mid-wife contact that is anothe DRG (light red colour) . I think mid-wifes are nurses, so this may divide the cases to two DRG's.
There are already different DRG-groups for midwifes (Y86O Övriga barn-morskebesök) and nurses (Y83O Övriga sjuksköterskebesök), so the midwife visits will still be assigned to DRG Y86O. The medical information about a visit is obviously higher if it is registered as a ‘midwife-visit’ than a ‘nurse-visit’, the vast majority of midwife-visits must certainly belong in MDC14.

4) Contacts for pain problems (blue colour) can be assigned to contacts with medical doctor, with nurse, with a team and with medical doctor by phone in this order. If team includes a nurse, should the contact be assigned to nurse contact group? In general the same question is valid for doctors also.
A team is registered as a team, procpro 99V22 Team of care providors, without the need to specify which professions are present.

5) Team contacts in general (light blue colour) all placed after the nurse contacts (and medical doctor contacts). Is it intended that the individual professionals are also registered when a team is involed.
Since the team visits are higher in the hierarchy than nurse- and doctor-visits the team-visits will be assigned as team-visits even if professions are also registered.

The attached technical changes file includes the unchanged parts of proc and procprop tables that influence the groupin. The logic table includes a large number of related rules that show a more broade picture of the changes. Using the column 'mark' or the colours one can see diffent aspects of the grouping.
The question that arise are obviously at least partly related to resource use of the different cases. Maybe some economical analysis might still be usefull.
We add a file (in Swedish) with economical data on nurse visits.

#3 Updated by Martti Virtanen about 1 year ago

  • Status changed from Active to Accepted

2018-03-13 Expert group.
The case wass accepted as proposed. Affects only Sweden.

#4 Updated by Veronika Stemme about 1 year ago

Veronika Stemme, NPK, Sweden
One change to this case: Sweden will not introduce a specific nurse-DRG in MDC 19, since we have decided that the DRG in psychiatric diseases should be diagnosis dependent and regardless of which professional the patient has met. Thus - DRG T97O ’Övriga sjuksköterskebesök vid psykiska besvär och drogberoende’ is deleted.

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