Case #586

Revision of DRG X70O/907V Intravascular drug delivery, short therapy

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

Status:AcceptedStart date:2018-02-05
Priority:MajorSpent 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

National Board of Health and Welfare, Sweden. CPK-ID 687
Problem
This is a proposal only for the Swedish version and it is published for information and possible discussion.
The DRG X70O/907V ‘Intravascular drug delivery, short therapy’ gives little medical information but the DRG has a high relative weight in the DRG-system due to the registration of cases with expensive drugs delivered. However, there is no specification of what drug is given or demand for diagnosis of the patient which means that also “cheap” drugs can lead to this high-weight-DRG. To enhance the medical description for these cases we suggest the creation of MDC-specific DRG-groups in the 10 MDC where the most frequent diagnoses in DRG X70O/907V are found.
We also suggest that DRG X72O/914V 'Läkemedelstillförsel, övrig mindre resurskrävande, besök' and DRG X72R 'Läkemedelstillförsel, övrig mindre resurskrävande, primärvård' are deleted because of few cases in these groups and the mean cost in DRG X72O do not differ much from a visit without registered procedure. We think the medical description will be better if the cases will be directed to MDC-specific visit groups for doctors or nurses rather than to X72O/R.

Analysis
We have analyzed Swedish patient data from 2016 to see which diagnoses were most frequent in the DRG X70O/907V ‘Intravascular drug delivery, short therapy’. From this analysis we concluded that diagnoses in the following 10 MDC were most abundant:
MDC 01 Diseases and Disorders of the Nervous System
MDC 04 Diseases and Disorders of the Respiratory System
MDC 06 Diseases and Disorders of the Digestive System
MDC 08 Diseases and Disorders of the Musculoskeletal System and Connective Tissue
MDC 11 Diseases and Disorders of the Kidney and Urinary Tract
MDC 12 Diseases and Disorders of the Male Reproductive System
MDC 13 Diseases and Disorders of the Female Reproductive System
MDC 16 Diseases and Disorders of the Blood and Blood Forming Organs and Immunological Disorders
MDC 17 Myeloproliferative DDs (Poorly Differentiated Neoplasms)
MDC 30 Diseases of the Mammary gland

See attached file ‘Diagnoses in DRG X70O.xlsx’

We suggest that new MDC-specific DRG-groups for intravascular drug delivery are created in these 10 MDC (for outpatient care and primary care) with the intention to improve the medical description.

Suggestion
New outpatient-DRG-groups and primary care-DRG groups for intravascular drug delivery are introduced in MDC 01, 04, 06, 08, 11, 12, 13, 16, 17 and 30.
DRG X72O/914V 'Läkemedelstillförsel, övrig mindre resurskrävande, besök' and DRG X72R 'Läkemedelstillförsel, övrig mindre resurskrävande, primärvård' are deleted.

Decided changes
We want the changes to be implemented in the Swedish NordDRG for 2019.

DRG change
Cases in MDC 01, 04, 06, 08, 11, 12, 13, 16, 17 and 30 which now are assigned to DRG X70O/907V ‘Intravascular drug delivery, short therapy’ will instead be grouped to new MDC specific DRG-groups in respective MDC. DRG X70O/907V ‘Intravascular drug delivery, short therapy’ will still be present for cases in the other MDC´s.
Cases that are now assigned to DRG X72O/914V 'Läkemedelstillförsel, övrig mindre resurskrävande, besök' and DRG X72R 'Läkemedelstillförsel, övrig mindre resurskrävande, primärvård' will instead be grouped to visit-DRG’s (for doctor, nurse or other professional).

Technical change
New outpatient-DRG-groups and primary care-DRG-groups for intravascular drug delivery are introduced in MDC 01, 04, 06, 08, 11, 12, 13, 16, 17 and 30.
DRG X72O/914V 'Läkemedelstillförsel, övrig mindre resurskrävande, besök' and DRG X72R 'Läkemedelstillförsel, övrig mindre resurskrävande, primärvård' are deleted. ProcPr 40V27 ’Minor intervention for medication’ is deleted since it is only used in DRG X72O/R.

See file: ‘Technical_changes_CPK-ID 687.xlsx’

Technical_changes_CPK-ID 687.xlsx (26.8 KB) Veronika Stemme, 2018-02-05 13:29

Diagnoses in DRG X70O.xlsx (52.6 KB) Veronika Stemme, 2018-02-05 13:29

Technical changes case #586.xlsx (35.6 KB) Martti Virtanen, 2018-02-20 13:45

Fel i TC C693 upptäckt 20180511, måste korrigeras.xlsx (10.1 KB) Ralph Dahlgren, 2018-05-11 02:09

Tiedoston Technical changes case #586-2.xlsx (36.1 KB) Martti Virtanen, 2018-09-04 17:04

History

#1 Updated by Martti Virtanen about 2 years ago

  • File Technical changes case #586.xlsx added

2018-02-13 Martti Virtanen
This proposal is technically ok. The economical analysis of the order of the rules is obviously missing and unclear, but the proposed order is probably acceptable.
It is questionable whether we should create more groups separating treatment of diseases of male and female genitalia. Is there any information about the dirrerences in resource use between thsese groups? At leasst, the swedish names of groups should be reconsidered.
A man that has changed gender and is now a woman in many cases can still have diseses of female genitalia but he is a woman. And obiously vice versa.
('vid sjukdomar i manliga 'genitalia in stead of 'vid sjukdomar i genitalia hos man'). Your englisht text in the proposal is correct.

In Swedish: En man kan ha sjukdomar av kvinnliga genitalia, men h*e*n är inte en kvinna. (:

Please note in addition:
Technically the nat_ver of all proposed (and removed) logic lines is Swe.
The Id of the rules is currently in practice identical with the Ord but the rules that are moved for thecnical reasons retain their old Id.
I have added these feature to the technical changes that is added to this case.

#2 Updated by Martti Virtanen about 2 years ago

  • File Technical changes case #586.xlsx added

#3 Updated by Martti Virtanen about 2 years ago

  • File deleted (Technical changes case #586.xlsx)

#4 Updated by Martti Virtanen about 2 years ago

  • File deleted (Technical changes case #586.xlsx)

#5 Updated by Martti Virtanen about 2 years ago

  • File deleted (Technical changes case #586.xlsx)

#7 Updated by Veronika Stemme about 2 years ago

Veronika Stemme, NPK, Sweden
The questions about MDC:s 12, 13 and 98 certainly needs further discussion. The case #496 concerning gender issues is still open so the discussion probably best belongs there. One possibility could be to keep the cases in MDC 98 in that MDC, without assigning them to MDC:s 12 or13, and keep the MDC:s 12 and 13 as they are now.

#8 Updated by Ralph Dahlgren almost 2 years ago

2018-05-11 Ralph Dahlgren
Liselotte S discovered some error in the technicall Changes to this case.
Correction in DRGlogic is necesarry.
The corrections is in the enclosed Excel-file.

#9 Updated by Ralph Dahlgren almost 2 years ago

2018-05-14 Ralph Dahlgren
The comment above is obviously in the wrong case.
Sorry about that.

#10 Updated by Martti Virtanen over 1 year ago

2018-09-04 Martti Virtanen
Thanks to the work with test cases we founrd an error in this case.
The new rules for primary care are mostly placed after exitisting rule for intravascular drug therapy DRG X70R (#00D001735). Because they all use the property 40V20 (intravenous drug delivery) and because X70R takes all cases with 40V20 and 99X50 (primary care) the rules after X70R will not function. Therefor X70R rule has to be moved behind the rule for DRG O89R (for exqample #00D003079)

#11 Updated by Ralph Dahlgren over 1 year ago

2018-09-14 Ralph Dahlgren
The most important thing in the collaboration is that we help eachother. So therefore I appreciate the comment.
But for once Sweden has thanks to Liselotte S Prodacapo already gotten information about the problem Before this summer. In the Swedish updates for 2019 that was devided into two cases the changes was already done.
To avoid any futher work for this case Sweden change our ord value to the one suggested by Martti.
Everyone must understand and remeber the know that the technical Changes from Sweden in case #594, MW TC #595 is not correct.
Because Sweden will not enclose any more changes to this case to avoid any futher confusion.
This is on the right case this time.

#12 Updated by Martti Virtanen over 1 year ago

  • Status changed from Active to Accepted

2018-03-13 Expert gorup
Expert group accepted the case for NordDRG Swe.
For further discussion se above.

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