Case #61

Development initiative #74: Development of grouping MDC15 - Newborn

Case 2013-MDC15-01 - Neonates under birth weight less than 1000g in DRG 385B (Follow-up care of neonatal problems or delayed neonatal problem)

Added by Anonymous over 7 years ago. Updated over 7 years ago.

Status:AcceptedStart date:2013-08-28
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2013
Initiator:Finland Target year:2014
MDC:MDC15 Owner / responsible:National organisations
Target Grouper:COMMON Old forum status:ACTITEM - Active item

Description

Last updated: 2013-03-27

Status:

ACTITEM - Active item

Initiated:2011

Initiator: Helsinki University Hospital

Responsible at NPK: Kristiina Kahur, Minna-Liisa Sjöblom

Sent to NordDRG Forum (date): 27.1.2013

 

Expert Network 2013-03-12 Change recommended

Board 2013-03-27 Change accepted


Problem

Finnish national DRG-center got a proposal from Helsinki University Hospital and also from Central Finland Central Hospital that MDC 15 should be analyzed and tested. The working group went through the DRGs in MDC15 and came up with two proposals for change to the grouping logic in some DRGs.

Secondary care of neonates with birth weight less than 1000 g proved to be much more expensive than other neonatal follow-up care (DRG 385B) and thus do not belong to that group neither by resource use nor clincially

Analysis

For analysis the cases of year 2011 grouped to MDC 15 were used. The data was combined from five Finnish university hospitals as well as from central hospitals. For grouping Finnish 2011 Full version was used.

The neonates with birth weight < 1000 g proved to be much more expensive than other cases in DRG 385B. Also clinically the secondary care  is not distinctive from other care of these tiny babies. Therefore they should be assigned to DRG 368N

Suggestion

If the birth weight of a newborn inpatient is under 1000 g (ICD10plus codes P070A, P070B, P070C), the case should always be assigned to the DRG 386N (Neonate, birth weight under 1000 g).

Swedish comment 2013-03-08

Swedish cost data (KPP 2011):

Also in Swedish data, the P070 cases within DRG 385B/Q10N are more expensive than the rest in that group, but they are not so expensive that they fit in DRG 386N/Q15N. Therefore we do not support the suggestion to move the P070 cases within DRG 385B/Q10N to DRG 386N/Q15N. A possible alternative is to let the P070 cases within DRG 385B/Q10N to become a new separate DRG. All criteria for such a split are fulfilled.

 

Expert group – 2013-03-12

The expert group recommends that a new DRG is created for Follow-up care of neonates with birth weight less than 1000 g.

Decided changes

DRG change

After care of neonates with birth weight less than 1000 g will be assigned to a new DRG 385C 'Follow-up care of neonates with birth weight less than 1000 g'. The grouping demands that a diagnosis from the P070 group (different in different NordDRG countries) is registered as primary or secondary diagnosis.

Technical change

A new DRG is created

385C/Q12N?  'Follow-up care of neonates with birth weight less than 1000 g'

The name of the DRG 385B/Q10N will be changed to:

385B/Q10N 'Follow-up care of neonatal problems or delayed neonatal problem, birth weight 1000 g or more'

 
Two new rules are created immediately before current rule 015D80101 for DRG 385B/Q10N.

The first of these rules is a copy of rule 015D80101 with Dgprop1 given value 15X23 and DRG changed to 385C

The second is a copy of the rule 015D80111 with the same changes as before.

table1.jpg (41.4 KB) Anonymous, 2013-08-29 07:30

table2.jpg (85.4 KB) Anonymous, 2013-08-29 07:30

History

#1 Updated by Anonymous over 7 years ago

  • Description updated (diff)

#2 Updated by Anonymous over 7 years ago

#3 Updated by Anonymous over 7 years ago

  • Description updated (diff)

#4 Updated by Anonymous over 7 years ago

  • Target version set to Expert Group 2013

#5 Updated by Anonymous over 7 years ago

  • Old forum status set to ACTITEM - Active item

#6 Updated by Anonymous over 7 years ago

  • Target year 2014 added
  • Owner / responsible National organisations added
  • Initiator Finland added

#7 Updated by Anonymous over 7 years ago

  • Target year 2011, 2013 added

#8 Updated by Anonymous over 7 years ago

  • Priority changed from Normal to 11

#9 Updated by Anonymous over 7 years ago

  • Priority changed from 11 to Normal

#10 Updated by Anonymous over 7 years ago

  • Status changed from Active to Accepted
  • Case type set to Major
  • Target year deleted (2011, 2013)
  • Target Grouper COMMON added

#11 Updated by Anonymous over 7 years ago

  • Parent task set to #74

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