Case #582

Psychiatry DRG's subgroupings, (Swedish) primary care, outpatients, inpatients

Added by Ralph Dahlgren over 2 years ago. Updated over 1 year ago.

Status:AcceptedStart date:2018-01-26
Priority:NormalSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Target version 2019
Initiator:Sweden Target year:2019
Case type:Major Owner / responsible:National organisations
MDC:MDC19 Old forum status:
Target Grouper:SWE

Description

2018-01-26 Ralph Dahlgren
Development of Swedish NordDRG Psychiatry
Problem:
Since the Swedish definition tables contain very little Open Daycare DRG in psychiatry, a development has been decided to be done. This decision came also out of the fact that the Swedish Patient Registry (PAR) from the end of 2018 will start to collect other health care provider than doctors. In psychiatry somewhere around 75-83% of treatments are done by others than doctors.
Historically, when the work for psychiatry was done in beginning of 2000, there was no data to do more DRG for open daycare than the existing ones. For In care, DRG was done partly from a medical perspective, partly on Cost data (KPP= Cost per patient) data.
Nowadays, there are much better KPP data. There are certain data in KPP Somatic that is grouped into T-DRG (Psychiatric DRG). Most of all, KPP Psychiatry has developed very much in recent years. 2016 KPP Psychiatry has data from 18 county councils / regions. Data available is constantly improving in quality both regarding quality in primary classification and costs.
There is still a lack of primary classification quality within Psychiatry that affects the possibility of dividing DRG in In care to 3 levels, "not CC", "CC" and "MCC". This is clear since there are other studies showing a greatly increased somatic disease burden and premature death for this patient group. However, this does not appear in the coding for PAR or KPP data for psychiatry.
The development of the new DRGs that has been done by grouping both PAR and KPP Somatik, KPP Psychiatry with division into 3 complication levels for In patient care and in 2 levels in Open daycare.
Analysis
National Board of Health and Welfare, Sweden – 2018-01-25
Analysis has been don to the Swedish cost data for both Somatic and Phychiatry and the Swedish Patient registry.
Suggestion
National Board of Health and Welfare, Sweden – 2018-01-25
For the existing In care DRG in Psychiatry, which has previously had no CC levels, have been divided into not complicated, complicated in most cases. In some cases, the division also include a very complicated level.
The Specialized Psychiatric outpatient is in principle a reflection of the Incare DRGlogic. The same applies to Primary Care.
Decided changes
National Board of Health and Welfare, Sweden – 2018-01-25
Sweden needs these changes to be done for the Swedish Definition tables for 2019, see above why.
The Swedish suggestion is that the NCMC do not implement these changes into the Common version until 2020. This due to the fact that there are a lot of changes and Martti have a lot to do concerning the new NDMS. The changes are done so no other country will be affected.
DRG change
Open daycare patiens will be grouped to the same type of DRG that already exists for In-care patients, there are mostly two levels, No CC and CC.
For In-care patients that has previously had no CC levels, have been divided into not complicated, complicated in most cases. In some cases, the division also include a very complicated level. This correlate well to the possible grouping during the work done.
Technical change
To avoid making a very, very long text the one interested are asked to look in the Excel File “Decision for C737 Development of Swedish NordDRG Psychiatry”

Decision C737 Development of Swedish Psychiatry.xlsx (91.8 KB) Ralph Dahlgren, 2018-01-26 11:55

Technical changes case #582.xlsx (145 KB) Martti Virtanen, 2018-03-05 19:28

Technical changes case _582 Additions 20180320 by SWE.xlsx (18.9 KB) Ralph Dahlgren, 2018-03-20 10:40

Technical changes case #582 - 2.xlsx (146 KB) Martti Virtanen, 2018-12-19 12:02

History

#1 Updated by Martti Virtanen over 2 years ago

  • File Technical changes case #582.xlsx added

2018-03-05 Martti Virtanen
This proposal had some obvious errors that would distort the structure of the NordDRG grouper and it needs revision.
The main problem is that diagnosis categories cannot be removed, since MDC will disappear simultaneously.
Happily all proposed removals are unnecessary as are all added principal diagnosis properties. A rule stating MDC 19 with a principal diagnosis belonging to MDC 19 and having the same end value as the existing diagnosis category (for example 19P01 and 19M01) can in the logic be subtitued by the diagnosis category at issue. Some of the new logic lines were also unnecessary because of this.
The use of the propety 50X55 'CC-grundande' i.e. diagnosis complicating without exclusions is not standard for NordDRG. It is a very strong proeperty (like CC=1 for interventions). It is only used for Swedish outpatient and homevisit DRG's and can as such be accepted.
The ORD values need not to be changed if order does not change. ID must remain the same, if the rule does not change. A rule repeating the original (pre-existing) rule can use the same ID as the pre-existing rule even if DRG is changed (for example to '..., uncomplicated')
The revised technical changes gives the same DRG assignment as the original intention.

#2 Updated by Martti Virtanen over 2 years ago

  • Subject changed from Development of Swedish NordDRG Psychiatry to Psychiatry DRG's subgroupings, (Swedish) primary care, outpatients, inpatients

#3 Updated by Martti Virtanen over 2 years ago

#4 Updated by Martti Virtanen over 2 years ago

  • File deleted (Technical changes case #582.xlsx)

#5 Updated by Ralph Dahlgren over 2 years ago

2018-03-20 Ralph Dahlgren
Sweden has now gone through the technical Changes from Martti and adjusted our according to the decision at the Expert meeting 20180312 on Island. Switch from PDGPROP to DGCAT.
While going through the technical Changes and also make one more controll of the "ord" values in the DRGlogic table so that there (hopefully are no errors) I found out that there were two more lines in DRGlogic table that has to be changed.
The Changes are shown in the included Excell-file today.

#6 Updated by Martti Virtanen over 1 year ago

2018-03-13 Expert group
Expert group accepted the Swedish change that demanded some further work (see above).
The corrections are included in the updated Technical changes document.
The chnages are minor and ID's of ther rules remain unchanged. Ord-values need now change, becaus the postion is not changed.

#7 Updated by Martti Virtanen over 1 year ago

  • Status changed from Active to Accepted

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